Provider Demographics
NPI:1285909432
Name:COSTAMED
Entity type:Organization
Organization Name:COSTAMED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGOVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-301-4111
Mailing Address - Street 1:102 VERSAILLES BLVD STE 208
Mailing Address - Street 2:ATTN: CHRISTINE SMITH LOCKBOX 3633
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6703
Mailing Address - Country:US
Mailing Address - Phone:877-207-0233
Mailing Address - Fax:
Practice Address - Street 1:CALLE PRIMERA SUR NO. 101,
Practice Address - Street 2:
Practice Address - City:COZUMEL
Practice Address - State:QR
Practice Address - Zip Code:77640
Practice Address - Country:MX
Practice Address - Phone:855-301-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital