Provider Demographics
NPI:1699412700
Name:SMART BUSINESS GROUP
Entity type:Organization
Organization Name:SMART BUSINESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA VAZQUEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:787-410-6076
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704-0540
Mailing Address - Country:US
Mailing Address - Phone:787-410-6076
Mailing Address - Fax:787-803-9093
Practice Address - Street 1:CARR 3 KM 152.1 BARRIADA LOPEZ
Practice Address - Street 2:BARRIO AGUIRRE
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-410-6076
Practice Address - Fax:787-803-9093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMART PEDIATRIC CARE MEDICAL SUPPLIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039229900Medicaid