Healthcare Provider Details

I. General information

NPI: 1558535849
Provider Name (Legal Business Name): J A T MEDICAL SERVICE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 638 KM 6.0 BARRIO MIRAFLORES
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 2512
ARECIBO PR
00613-2512
US

V. Phone/Fax

Practice location:
  • Phone: 787-816-1028
  • Fax: 787-816-1028
Mailing address:
  • Phone: 787-816-1028
  • Fax: 787-816-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number12050
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE ACEVEDO
Title or Position: PRESIDENTE
Credential:
Phone: 787-816-1028