Provider Demographics
NPI:1992773980
Name:SERVICIOS MEDICOS DE HORMIGUEROS INC
Entity type:Organization
Organization Name:SERVICIOS MEDICOS DE HORMIGUEROS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROVIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-849-0111
Mailing Address - Street 1:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1520
Mailing Address - Country:US
Mailing Address - Phone:787-849-0111
Mailing Address - Fax:787-849-0707
Practice Address - Street 1:CALLE LUIS MUNOZ MARTIN 2
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-849-0111
Practice Address - Fax:787-849-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR44261Q00000X, 261QE0002X, 261QR0200X
PR740291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
030385OtherCRUZ AZUL
31321OtherTRIPLE S
81089OtherTRIPLE S
19169OtherTRIPLE S
030385OtherBLUE CROSS BLUE SHIELD
064740OtherGLOBA HEALTH PLAN
19169OtherBLUE CROSS BLUE SHIELD
31321OtherBLUE CROSS BLUE SHIELD
6600016OtherHUMANA HEALTH
81089OtherBLUE CROSS BLUE SHIELD
=========OtherACE INSURANCE
=========OtherFIRST PLUS
19169OtherTRIPLE S
=========OtherCOSIVMED
31321OtherTRIPLE S
81089OtherBLUE CROSS BLUE SHIELD
=========OtherAMERICAN HEALTH INSURANCE
=========OtherCIGNA
=========OtherMAPFRE
31321OtherBLUE CROSS BLUE SHIELD