Provider Demographics
NPI:1356721294
Name:RIVERA COLON SURGICAL SERVICES, PSC
Entity type:Organization
Organization Name:RIVERA COLON SURGICAL SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-466-2961
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:HOSPITAL PAVIA ARECIBO SUITE 101
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613
Mailing Address - Country:US
Mailing Address - Phone:787-650-7272
Mailing Address - Fax:
Practice Address - Street 1:CARR 129 KM 1.1
Practice Address - Street 2:HOSPITAL PAVIA ARECIBO SUITE 101
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-650-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18709208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHW133AOtherMEDICARE PTAN