Provider Demographics
NPI:1063518579
Name:MEDICENTRO INC
Entity type:Organization
Organization Name:MEDICENTRO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-735-1560
Mailing Address - Street 1:PO BOX 2021
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2021
Mailing Address - Country:US
Mailing Address - Phone:787-735-1560
Mailing Address - Fax:787-735-1114
Practice Address - Street 1:204 CALLE JULIO CINTRON
Practice Address - Street 2:EDIF GUAYACAN SUITE 223
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3311
Practice Address - Country:US
Practice Address - Phone:787-735-1560
Practice Address - Fax:787-735-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1233060001Medicare NSC