Provider Demographics
NPI:1295146678
Name:LCS SURGICAL SERVICES PSC
Entity type:Organization
Organization Name:LCS SURGICAL SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CARCORZE SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-951-7074
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0819
Mailing Address - Country:US
Mailing Address - Phone:787-951-7074
Mailing Address - Fax:
Practice Address - Street 1:15 CALLE DR BASORA N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4833
Practice Address - Country:US
Practice Address - Phone:787-834-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18625208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1689807968OtherNPI PERSONAL
PR18625OtherLICENCIA MEDICO PUERTO RICO