Provider Demographics
NPI:1972594836
Name:SUR-MED MEDICAL CORP.
Entity type:Organization
Organization Name:SUR-MED MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-204-3282
Mailing Address - Street 1:8 CALLE COLON PACHECO
Mailing Address - Street 2:PO BOX 1162
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-3344
Mailing Address - Country:US
Mailing Address - Phone:787-824-7097
Mailing Address - Fax:787-824-7655
Practice Address - Street 1:8 CALLE COLON PACHECO
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3344
Practice Address - Country:US
Practice Address - Phone:787-824-7097
Practice Address - Fax:787-824-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR743291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31179Medicare ID - Type Unspecified