Provider Demographics
NPI:1780355610
Name:HOSPITAL MEDICA DE LA CIUDAD
Entity type:Organization
Organization Name:HOSPITAL MEDICA DE LA CIUDAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARACELY LIZBETH
Authorized Official - Middle Name:QUINONEZ
Authorized Official - Last Name:GALLARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:333-883-2088
Mailing Address - Street 1:5830 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE PABLO VALDEZ 719, LA PERLA,
Practice Address - Street 2:
Practice Address - City:GUADALAJARA
Practice Address - State:JALISCO
Practice Address - Zip Code:44360
Practice Address - Country:MX
Practice Address - Phone:333-883-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
HEVJ7206005HCCRLR04OtherSTATE