Healthcare Provider Details

I. General information

NPI: 1093855041
Provider Name (Legal Business Name): SOUTHERN HOSPITAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CALLE MUNOZ RIVERA
VILLALBA PR
00766-3043
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: 787-847-8164
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 Number07-F-1847
License Number StatePR

VIII. Authorized Official

Name: MR. ARMANDO MUNOZ
Title or Position: PRESIDENT
Credential: M.D
Phone: 78783722654