Provider Demographics
NPI:1770580813
Name:PRESBYTERIAN COMMUNITY HOSPITAL, INC
Entity type:Organization
Organization Name:PRESBYTERIAN COMMUNITY HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAHI
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVALLE GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-721-2160
Mailing Address - Street 1:PO BOX 9020032
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-0032
Mailing Address - Country:US
Mailing Address - Phone:787-721-2160
Mailing Address - Fax:787-723-3797
Practice Address - Street 1:1451 ASHFORD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1511
Practice Address - Country:US
Practice Address - Phone:787-721-2160
Practice Address - Fax:787-723-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 333600000X, 261QA1903X, 261QE0002X, 261QE0800X, 261QM1200X, 261QP2000X, 261QR0200X, 261QR0206X, 207U00000X
PR61282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
No333600000XSuppliersPharmacy
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400001Medicare ID - Type Unspecified