MEDICARE: MENNONITE GENERAL 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1144099813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENNONITE GENERAL HOSPITAL INC.

Provider Business Mailing Address
First Line	:	PO BOX 1650
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739-1650
Country	:	US
Telephone Number	:	787-434-1700
Fax Number	:	787-535-1711

Provider Business Practice Location Address
First Line	:	TORRE SAN CRISTOBAL OFICINA #309
Second Line	:	COTO LAUREL
City	:	PONCE
State	:	PR
Zip	:	00780-2856
Country	:	US
Telephone Number	:	787-434-1700
Fax Number	:	787-434-1715

Authorized Official
Title or Position	:	DIRECTOR OF BILLING AND COLLECTION
Name	:	LISSETTE VASQUEZ RIVERA
Credential	:
Telephone Number	:	787-434-1700

Provider Enumeration Date	:	12/22/2023
Last Update Date	:	01/14/2025

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