Healthcare Provider Details

I. General information

NPI: 1780652594
Provider Name (Legal Business Name): SOUTH WESTERN RADIOLOGY SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D10 CALLE 2 URB. VILLA REAL
VEGA BAJA PR
00693-4611
US

IV. Provider business mailing address

PO BOX 1498
VEGA BAJA PR
00694-1498
US

V. Phone/Fax

Practice location:
  • Phone: 787-807-0900
  • Fax: 787-855-2729
Mailing address:
  • Phone: 787-807-0900
  • Fax: 787-855-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number05-265
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number05-265
License Number StatePR

VIII. Authorized Official

Name: DR. MANUEL MEDINA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-807-0900