Provider Demographics
NPI:1700520202
Name:SOUTH MEDICAL RESPONSE
Entity Type:Organization
Organization Name:SOUTH MEDICAL RESPONSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:939-320-9011
Mailing Address - Street 1:19 CALLE DUARTE
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1132
Mailing Address - Country:US
Mailing Address - Phone:787-405-2227
Mailing Address - Fax:
Practice Address - Street 1:296 BETANCES
Practice Address - Street 2:SUITE 7
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1132
Practice Address - Country:US
Practice Address - Phone:787-405-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance