Provider Demographics
NPI:1801447271
Name:SOUTHERN MEDICAL ALLIANCE, INC.
Entity type:Organization
Organization Name:SOUTHERN MEDICAL ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-856-0908
Mailing Address - Street 1:PO BOX 3004
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3004
Mailing Address - Country:US
Mailing Address - Phone:787-267-8822
Mailing Address - Fax:787-856-8833
Practice Address - Street 1:ESQUINA PASARELL # 19 CALLE 25 DE JULIO
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-267-8822
Practice Address - Fax:787-856-8833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN MEDICAL ALLIANCE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care