Healthcare Provider Details

I. General information

NPI: 1679905608
Provider Name (Legal Business Name): HOSPITAL EPISCOPAL SAN LUCAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. TITO CASTRO 917
PONCE PR
00716
US

IV. Provider business mailing address

PO BOX 9784
ARECIBO PR
00613-9794
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number030717R
License Number StatePR

VIII. Authorized Official

Name: WILLIAM SANTIAGO
Title or Position: RESIDENCY PROGRAM DIRECTOR
Credential: MD
Phone: 787-844-2080