=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609177146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARD SHANNON LIMITED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2010
-----------------------------------------------------
Last Update Date | 05/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 CALLE 2 STE 620 METRO OFFICE PARK
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00968-1787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-238-1017
-----------------------------------------------------
Fax | 787-804-1533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 CALLE 2 STE 620 METRO OFFICE PARK
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00968-1787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-238-1017
-----------------------------------------------------
Fax | 787-804-1533
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SALES MANAGER
-----------------------------------------------------
Name | MIKE K FLORES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-238-1017
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------