Healthcare Provider Details

I. General information

NPI: 1073507844
Provider Name (Legal Business Name): MENNONITE GENERAL HOSPITAL,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOSE C VAZQUEZ ST.
AIBONITO PR
00705-1379
US

IV. Provider business mailing address

PO BOX 1379
AIBONITO PR
00705-1379
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-1955
  • Fax: 787-735-1525
Mailing address:
  • Phone: 787-735-1955
  • Fax: 787-735-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number15
License Number StatePR

VIII. Authorized Official

Name: MRS. MARTA ROSA MERCADO
Title or Position: ADMINISTRATOR
Credential: MHSA
Phone: 787-735-1955