MEDICARE: SERVICIOS MEDICOS UROLOGIA CSP

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	208800000X	Urology Physician	8385	PR

General Provider Information

NPI Number	:	1285635607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICIOS MEDICOS UROLOGIA CSP

Provider Business Mailing Address
First Line	:	PO BOX 789
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-0789
Country	:	US
Telephone Number	:	787-622-0704
Fax Number	:	787-622-0705

Provider Business Practice Location Address
First Line	:	BAYAMON MEDICAL PLZ
Second Line	:	1845 ROAD 2 STE 602
City	:	BAYAMON
State	:	PR
Zip	:	00959-7200
Country	:	US
Telephone Number	:	787-622-0704
Fax Number	:	787-622-0705

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BENEDICTO COLON
Credential	:	MD
Telephone Number	:	787-622-0704

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/09/2023

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