Provider Demographics
NPI:1548389380
Name:SERVICIOS MEDICOS LAS MARIAS,INC.
Entity type:Organization
Organization Name:SERVICIOS MEDICOS LAS MARIAS,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:I
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-827-2230
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:LAS MARIAS
Mailing Address - State:PR
Mailing Address - Zip Code:00670-0023
Mailing Address - Country:US
Mailing Address - Phone:787-827-2230
Mailing Address - Fax:787-827-4155
Practice Address - Street 1:AVE. FLAMBOYAN NO. 237
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-4242
Practice Address - Fax:787-899-8023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84394Medicare ID - Type Unspecified