Provider Demographics
NPI:1104815737
Name:GRUPO RADIOTERAPIA DEL NORTE
Entity type:Organization
Organization Name:GRUPO RADIOTERAPIA DEL NORTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHEVERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-621-0021
Mailing Address - Street 1:PMB 298
Mailing Address - Street 2:PO BOX 30500
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-621-0021
Mailing Address - Fax:787-621-0023
Practice Address - Street 1:ROAD #2 KM 47.7
Practice Address - Street 2:
Practice Address - City:MANAT
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-0021
Practice Address - Fax:787-621-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84655Medicare ID - Type Unspecified