Healthcare Provider Details

I. General information

NPI: 1790804680
Provider Name (Legal Business Name): SOUTHERN HOSPITAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CALLE MUNOZ RIVERA
VILLALBA PR
00766-2221
US

IV. Provider business mailing address

PO BOX 1400
JUANA DIAZ PR
00795-1400
US

V. Phone/Fax

Practice location:
  • Phone: 787-847-3000
  • Fax: 787-260-1441
Mailing address:
  • Phone: 787-837-2265
  • Fax: 787-260-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCO SOLDEVILA
Title or Position: ACCOUNTANT
Credential:
Phone: 787-837-2265