Provider Demographics
NPI:1861421661
Name:AMBULANCIAS EMERGENCIAS DEL SUR
Entity type:Organization
Organization Name:AMBULANCIAS EMERGENCIAS DEL SUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:SALIVA MANTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:787-843-6985
Mailing Address - Street 1:PO BOX 692
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0692
Mailing Address - Country:US
Mailing Address - Phone:787-843-6985
Mailing Address - Fax:787-290-4003
Practice Address - Street 1:3069 CRUZ ST. ELGICA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-3069
Practice Address - Country:US
Practice Address - Phone:787-843-6985
Practice Address - Fax:787-290-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 1103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR890391OtherMEDICARE Y MUCHO MAS
PR53511OtherTRIPLE S REFORMA
PR7310409OtherHUMANA REFORMA
PR9003347OtherACCA
PR50515OtherPREFERRED MEDICAL CHOICE
PR0059256Medicare UPIN