Provider Demographics
NPI:1982785499
Name:ST. PETER AMBULANCE
Entity Type:Organization
Organization Name:ST. PETER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGE FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-839-4050
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-1210
Mailing Address - Country:US
Mailing Address - Phone:787-839-4050
Mailing Address - Fax:787-839-4074
Practice Address - Street 1:CARR 184 KM 0.8
Practice Address - Street 2:BO. CACAO BAJO
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-839-4050
Practice Address - Fax:787-839-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB-3323416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR890563OtherMMM HEALTHCARE
PR7140019OtherHUMANA HEALTH PLAN
PR890563OtherMMM HEALTHCARE
PR=========OtherCOSVI
PR=========OtherMEDICAL CARD SYSTEM
PR=========OtherCOSVI