Provider Demographics
NPI:1124386131
Name:MDI HEALTH CORPORATION
Entity type:Organization
Organization Name:MDI HEALTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-626-6692
Mailing Address - Street 1:425 CARR 693
Mailing Address - Street 2:PMB 360
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4816
Mailing Address - Country:US
Mailing Address - Phone:787-626-6692
Mailing Address - Fax:877-711-9868
Practice Address - Street 1:CARR. #2 KM 28.2 H8 SUITE 3
Practice Address - Street 2:BO. ESPINOZA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-9248
Practice Address - Country:US
Practice Address - Phone:787-396-3711
Practice Address - Fax:877-841-3357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6754320001Medicare NSC