Provider Demographics
NPI:1790776334
Name:NEOMED CENTER, INC
Entity type:Organization
Organization Name:NEOMED CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASTRO-AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-737-2311
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1277
Mailing Address - Country:US
Mailing Address - Phone:787-737-2311
Mailing Address - Fax:787-737-0244
Practice Address - Street 1:941 SAN ANTONIO FINAL ST RT
Practice Address - Street 2:SALIDA BARRIO JAGUAS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-1277
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:787-737-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 261QD0000X, 261QE0002X, 261QM0850X, 261QM0855X, 261QM1300X, 261QR0200X, 261QU0200X, 291U00000X, 3336C0003X
PR261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401832OtherMEDICARE PART A
PR84530Medicare UPIN