Provider Demographics
NPI:1740268663
Name:MENNONITE GENERAL HOSPITAL, INC.
Entity type:Organization
Organization Name:MENNONITE GENERAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-743-1121
Mailing Address - Street 1:PO BOX 9707
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9707
Mailing Address - Country:US
Mailing Address - Phone:787-743-3223
Mailing Address - Fax:787-286-8770
Practice Address - Street 1:CARR # 1 KM 34.9
Practice Address - Street 2:BO BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-3223
Practice Address - Fax:787-286-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAPM219332B00000X
PR0288930001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0288930001OtherPALMETTO
0288930001OtherPALMETTO