Provider Demographics
NPI:1861525115
Name:NORTHERN RADIOTHERAPY CANCER CENTER, P.S.C.
Entity type:Organization
Organization Name:NORTHERN RADIOTHERAPY CANCER CENTER, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISION
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-6070
Mailing Address - Street 1:PO BOX 8043
Mailing Address - Street 2:MARINA STATION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-8043
Mailing Address - Country:US
Mailing Address - Phone:787-650-6070
Mailing Address - Fax:787-834-5535
Practice Address - Street 1:AVE SAN LUIS #750 BO. HATO ARRIBA
Practice Address - Street 2:PR 129 KM 0.9
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-650-6070
Practice Address - Fax:787-834-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherFEDERAL TAX ID NUMBER