1538598099 NPI number — WEST UROLOGY GROUP PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538598099 NPI number — WEST UROLOGY GROUP PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST UROLOGY GROUP PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538598099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 CALLE PABLO CASALS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680-3944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA NUM 2 KM. 174.3
Provider Second Line Business Practice Location Address:
CAMINO PIN QUINONES
Provider Business Practice Location Address City Name:
SAN GERMAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-264-4905
Provider Business Practice Location Address Fax Number:
787-703-2929
Provider Enumeration Date:
11/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MUNIZ-COLON
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-402-8508

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  16871 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 328756 . This is a "CERTIFICACION DE REGISTRO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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