Provider Demographics
NPI:1982920062
Name:MEDCAN,PSC
Entity Type:Organization
Organization Name:MEDCAN,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACTURADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-740-3010
Mailing Address - Street 1:A8 AVE 65 INFANTERIA
Mailing Address - Street 2:URB. SAN AGUSTIN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1834
Mailing Address - Country:US
Mailing Address - Phone:787-740-3010
Mailing Address - Fax:787-740-3009
Practice Address - Street 1:A8 AVE 65 INFANTERIA
Practice Address - Street 2:URB. SAN AGUSTIN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-1834
Practice Address - Country:US
Practice Address - Phone:787-740-3010
Practice Address - Fax:787-740-3009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSCAN, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085243Medicare PIN