Provider Demographics
NPI:1285635607
Name:SERVICIOS MEDICOS UROLOGIA CSP
Entity type:Organization
Organization Name:SERVICIOS MEDICOS UROLOGIA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENEDICTO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-622-0704
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0789
Mailing Address - Country:US
Mailing Address - Phone:787-622-0704
Mailing Address - Fax:787-622-0705
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:1845 ROAD 2 STE 602
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-622-0704
Practice Address - Fax:787-622-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8385208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80635Medicare PIN