Healthcare Provider Details

I. General information

NPI: 1639246614
Provider Name (Legal Business Name): MEDICOR HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69-2 AVENIDA WEST MAIN SIERRA BAYAMON
BAYAMON PR
00961
US

IV. Provider business mailing address

PO BOX 70255
SAN JUAN PR
00936-8255
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5573
  • Fax:
Mailing address:
  • Phone: 800-250-4468
  • Fax: 866-930-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number05-P-2071
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier57166
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSSS PROVIDER NUMBER

VIII. Authorized Official

Name: MANUEL DELGADO
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-787-5573