Provider Demographics
NPI:1740279314
Name:CIV BIOMEDICAL SERVICES CORP
Entity type:Organization
Organization Name:CIV BIOMEDICAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:I
Authorized Official - Last Name:VILLAHERMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-896-0973
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0902
Mailing Address - Country:US
Mailing Address - Phone:787-636-7467
Mailing Address - Fax:787-896-0973
Practice Address - Street 1:CARR 109 RAMAL 497 KM 2.2
Practice Address - Street 2:BO POZAS
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-636-7467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4113480001Medicare NSC