MEDICARE: AJC SOFTWARE 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	335E00000X	Prosthetic/Orthotic Supplier		PR

General Provider Information

NPI Number	:	1205005410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AJC SOFTWARE INC.

Provider Business Mailing Address
First Line	:	PO BOX 336892
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00733-6892
Country	:	US
Telephone Number	:	787-492-0020
Fax Number	:	787-492-0021

Provider Business Practice Location Address
First Line	:	2612 AVENIDA LAS AMERICAS
Second Line	:	URB. CONSTANCIA
City	:	PONCE
State	:	PR
Zip	:	00717-2107
Country	:	US
Telephone Number	:	787-492-0020
Fax Number	:	787-492-0021

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ARMANDO J COLLAZO
Credential	:	MHSA
Telephone Number	:	787-492-0020

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	08/15/2014

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