Provider Demographics
NPI:1144438649
Name:SOCIEDAD MAYAGUEZ SURGICAL
Entity type:Organization
Organization Name:SOCIEDAD MAYAGUEZ SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SURIS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:787-834-7740
Mailing Address - Street 1:CALLE MENDEZ VIGO 109 E
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-834-7740
Mailing Address - Fax:
Practice Address - Street 1:CALLE MENDEZ VIGO 109 E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-7740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD83310Medicare UPIN