=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740400035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOCTORS CENTER HOSPITAL ARECIBO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2007
-----------------------------------------------------
Last Update Date | 10/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR. #2 KM 80
-----------------------------------------------------
City | ARECIBO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-878-0000
-----------------------------------------------------
Fax | 787-878-8106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CARR. #2 KM 80.1
-----------------------------------------------------
City | ARECIBO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-878-0000
-----------------------------------------------------
Fax | 787-878-8106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. PEDRO RIVERA LUGO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-854-3322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 708
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number | 07B0820
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------