MEDICARE: SAINT LUKES MEMORIAL HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	07F1901	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4023519	OTHER	PR	NABP

General Provider Information

NPI Number	:	1134245947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT LUKES MEMORIAL HOSPITAL INC

Provider Business Mailing Address
First Line	:	P O BOX 336810
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00733-6810
Country	:	US
Telephone Number	:	787-844-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVE. TITO CASTRO # 917
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00733-6810
Country	:	US
Telephone Number	:	787-843-1600
Fax Number	:	787-651-0572

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	MR. CARLOS M VALENTIN
Credential	:
Telephone Number	:	787-844-2080

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	04/03/2019

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