Provider Demographics
NPI:1891876439
Name:MOCA HOSPITAL SUPPLY, CORP
Entity type:Organization
Organization Name:MOCA HOSPITAL SUPPLY, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-877-1010
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1198
Mailing Address - Country:US
Mailing Address - Phone:787-877-1010
Mailing Address - Fax:787-818-1069
Practice Address - Street 1:CARR 444 KM 7 HM3 BO ROCHA
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-1010
Practice Address - Fax:787-818-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0274770001Medicare NSC