Provider Demographics
NPI:1538266952
Name:PROGRAMA MEDICO DEL NORTE, INC.
Entity type:Organization
Organization Name:PROGRAMA MEDICO DEL NORTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERALIST MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-462-2375
Mailing Address - Street 1:PO BOX 143114
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-3114
Mailing Address - Country:US
Mailing Address - Phone:787-820-9181
Mailing Address - Fax:787-820-9181
Practice Address - Street 1:CALLE FERNANDO VELAZQUEZ ESQUINA FRANKLIN D ROOSEVELT
Practice Address - Street 2:#70
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-9181
Practice Address - Fax:787-820-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0200X, 291U00000X, 3336C0002X, 3336C0003X, 261QE0002X
PR2185261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085230Medicare Oscar/Certification