Provider Demographics
NPI:1952376279
Name:KCI MEDICAL PUERTO RICO, INC.
Entity Type:Organization
Organization Name:KCI MEDICAL PUERTO RICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:HULSE
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:210-515-7338
Mailing Address - Street 1:6103 FARINON DR
Mailing Address - Street 2:ATTN HCC
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 CARR 869
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-7015
Practice Address - Country:US
Practice Address - Phone:787-275-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KCI MEDICAL PUERTO RICO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-21
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5047332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4043710001Medicare NSC