Provider Demographics
NPI:1801118559
Name:ASOCIACION MEDICOS SELECTOS DE LA MONTANA, INC.
Entity type:Organization
Organization Name:ASOCIACION MEDICOS SELECTOS DE LA MONTANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-869-5542
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0758
Mailing Address - Country:US
Mailing Address - Phone:787-869-5542
Mailing Address - Fax:787-869-5421
Practice Address - Street 1:4 CALLE URBANO RAMIREZ
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2219
Practice Address - Country:US
Practice Address - Phone:787-869-5542
Practice Address - Fax:787-869-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRIPA341OtherTRIPLE S