Provider Demographics
NPI:1992329155
Name:RENACER MEDICAL TRANSPORT INC
Entity type:Organization
Organization Name:RENACER MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ ROLDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-559-5186
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-0987
Mailing Address - Country:US
Mailing Address - Phone:787-559-5186
Mailing Address - Fax:
Practice Address - Street 1:BO FLORIDA CARR 183
Practice Address - Street 2:RAMAL 9929 KM 1.6
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-559-5186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR444409Medicaid