Provider Demographics
NPI:1912905506
Name:BAYAMON SMH CORPORATION
Entity Type:Organization
Organization Name:BAYAMON SMH CORPORATION
Other - Org Name:HATO REY X RAY & IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-754-1422
Mailing Address - Street 1:1353 AVE. LUIS VIGOREAUX
Mailing Address - Street 2:PMB 647
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:787-754-1422
Mailing Address - Fax:787-754-8555
Practice Address - Street 1:156 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2406
Practice Address - Country:US
Practice Address - Phone:787-754-1422
Practice Address - Fax:787-754-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM1200X, 261QR0200X, 261QR0206X
305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84961Medicare ID - Type UnspecifiedBAYAMON SMH CORP
PR84962Medicare ID - Type UnspecifiedBAYAMON SMH CORP