Provider Demographics
NPI:1215301965
Name:MENNONITE GENERAL HOSPITAL INC.
Entity type:Organization
Organization Name:MENNONITE GENERAL HOSPITAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING AND COLECCTION
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-434-1700
Mailing Address - Street 1:PO BOX 372800
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2800
Mailing Address - Country:US
Mailing Address - Phone:787-535-1001
Mailing Address - Fax:787-535-1114
Practice Address - Street 1:URB. LA HACIENDA
Practice Address - Street 2:AVENIDA PEDRO ALBIZU CAMPOS, BO. MACHETES
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-0011
Practice Address - Country:US
Practice Address - Phone:787-535-1001
Practice Address - Fax:787-535-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR404009Medicare Oscar/Certification