Provider Demographics
NPI:1770611220
Name:SERVICIO DE SALUD DEL NORTE
Entity type:Organization
Organization Name:SERVICIO DE SALUD DEL NORTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RECORD ROOM SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1787-817-3144
Mailing Address - Street 1:PO BOX 9980
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9980
Mailing Address - Country:US
Mailing Address - Phone:787-879-1585
Mailing Address - Fax:787-879-4315
Practice Address - Street 1:V1 CALLE 16
Practice Address - Street 2:URBANIZACION VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3112
Practice Address - Country:US
Practice Address - Phone:787-879-1585
Practice Address - Fax:787-879-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherTAX NUMBER