Provider Demographics
NPI:1881095339
Name:BELLA VISTA HOSPITAL INC
Entity type:Organization
Organization Name:BELLA VISTA HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:GRATACOS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:787-834-2350
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1750
Mailing Address - Country:US
Mailing Address - Phone:787-834-6000
Mailing Address - Fax:787-805-3705
Practice Address - Street 1:349 ST. KM 3.4
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0000
Practice Address - Country:US
Practice Address - Phone:787-834-6000
Practice Address - Fax:787-805-3705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLA VISTA HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400014OtherMEDICARE ID
PR1059480001Medicare NSC