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General NPI Number Information
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NPI Number | 1831183466
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Entity Type | Organization
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Legal Business Name | MENNONITE GENERAL HOSPITAL,INC.
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | JOSE C VAZQUEZ ST
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City | AIBONITO
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State | PR
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Zip | 00705-1379
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Country | US
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Telephone | 787-735-9206
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Fax | 787-735-7150
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Provider Business Mailing Address
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Address Line | PO BOX 1379
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City | AIBONITO
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State | PR
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Zip | 00705-1379
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Country | US
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Telephone | 787-735-9206
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Fax | 787-735-7150
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARTA ROSA MERCADO
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Credential | MHSA
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Telephone | 787-735-9206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | APM-047
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License Number State | PR
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