Provider Demographics
NPI:1811932908
Name:MAYAGUEZ ADVANCED RADIOTHERAPY CENTER
Entity type:Organization
Organization Name:MAYAGUEZ ADVANCED RADIOTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISION
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-6070
Mailing Address - Street 1:PO BOX 8043
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-8043
Mailing Address - Country:US
Mailing Address - Phone:787-834-6070
Mailing Address - Fax:787-834-5535
Practice Address - Street 1:AVE HOSTOS
Practice Address - Street 2:CENTRO MEDICO RAMON E. BETANCES
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-834-6070
Practice Address - Fax:787-834-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR592077OtherSER SALUD BELLA VISTA
PR510008OtherPREFERRED HEALTH
PR601345OtherMEDICARE & MUCHO MAS
PR3220-5OtherPROSAM
PR55-92077OtherPLAN DE SALUD UIA
PR7617OtherINTERNATIONAL MEDICAL CAR
PR900269OtherAMERICAN HEALTH, INC.
PR55-92077OtherPLAN DE SALUD UIA
PR7617OtherINTERNATIONAL MEDICAL CAR
PR601345OtherMEDICARE & MUCHO MAS
PR900269OtherAMERICAN HEALTH, INC.
PR=========OtherFEDERAL TAX ID NUMBER
PR=========OtherMAPFRE
PR3220-5OtherPROSAM
PR592077OtherSER SALUD BELLA VISTA