Provider Demographics
NPI:1215124680
Name:MANATI GASTROINTESTINAL OFFICE PSC
Entity type:Organization
Organization Name:MANATI GASTROINTESTINAL OFFICE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:ORTIZ
Authorized Official - Last Name:COTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-884-2426
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0411
Mailing Address - Country:US
Mailing Address - Phone:787-884-2426
Mailing Address - Fax:787-854-8005
Practice Address - Street 1:CARR. # 2 KM. 47.7
Practice Address - Street 2:HOSPITAL DOCTOR'S CENTER, TORRE ANTIGUA, OFICINA #404
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5507
Practice Address - Country:US
Practice Address - Phone:787-884-2426
Practice Address - Fax:787-854-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7736207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty