Provider Demographics
NPI:1831358407
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:939-717-3634
Mailing Address - Street 1:56 CALLE GEORGETTI
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-3000
Mailing Address - Country:US
Mailing Address - Phone:939-717-3634
Mailing Address - Fax:
Practice Address - Street 1:56 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3000
Practice Address - Country:US
Practice Address - Phone:939-717-3634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRIPA-341OtherTRIPLE S, INC.