Healthcare Provider Details

I. General information

NPI: 1871649988
Provider Name (Legal Business Name): SOUTHERN HOSPITAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE LA CRUZ #6
JUANA DIAZ PR
00795
US

IV. Provider business mailing address

PO BOX 1400
JUANA DIAZ PR
00795
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-2265
  • Fax: 787-260-1441
Mailing address:
  • Phone: 787-837-2265
  • Fax: 787-260-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number07F1848
License Number StatePR

VIII. Authorized Official

Name: ARMANDO L MUNOZ BERMUDEZ
Title or Position: PRESIDENTE
Credential:
Phone: 787-837-2265