Provider Demographics
NPI:1538432042
Name:MED CENTRO, INC.
Entity type:Organization
Organization Name:MED CENTRO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON-SALICHS
Authorized Official - Suffix:
Authorized Official - Credentials:MHC, HHCH
Authorized Official - Phone:787-843-9393
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0220
Mailing Address - Country:US
Mailing Address - Phone:787-843-9393
Mailing Address - Fax:787-841-0077
Practice Address - Street 1:CARR. 149 KM 55.2
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-843-9393
Practice Address - Fax:787-841-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0026172Medicare PIN