Healthcare Provider Details

I. General information

NPI: 1760968960
Provider Name (Legal Business Name): SAINT LUKES MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB INDUSTRIAL REPARADA 291 B CALLE MONTERREY BO CANAS
PONCE PR
00733
US

IV. Provider business mailing address

PO BOX 336810
PONCE PR
00733-6810
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax:
Mailing address:
  • Phone: 787-844-2080
  • Fax: 787-844-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number147
License Number StatePR

VIII. Authorized Official

Name: JULIO REYES
Title or Position: EHR PROJECT MANAGER
Credential:
Phone: 787-844-2080