Provider Demographics
NPI: | 1720424195 |
---|---|
Name: | METRO PAVIA HEALTHCARE CENTERS INC |
Entity Type: | Organization |
Organization Name: | METRO PAVIA HEALTHCARE CENTERS INC |
Other - Org Name: | METROPAVIA CLINIC CAROLINA |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | VIVIAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SOLIVAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 787-772-9850 |
Mailing Address - Street 1: | 400 CALLE CALAF |
Mailing Address - Street 2: | PMB 455 |
Mailing Address - City: | SAN JUAN |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00918-1314 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-772-9850 |
Mailing Address - Fax: | 787-274-8895 |
Practice Address - Street 1: | CARR 857 KM 13.4 |
Practice Address - Street 2: | BO CANOVANILLAS |
Practice Address - City: | CAROLINA |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00985 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-772-9850 |
Practice Address - Fax: | 787-274-8895 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-05-13 |
Last Update Date: | 2016-07-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QE0002X | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |