Basic Information
| Provider Information | |||||||||
| NPI: | 1225587207 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRUPO MEDICO HOSPITAL DAMAS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOSPITAL DAMAS, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2213 BY PASS | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878408686 | ||||||||
| FaxNumber: | 7878408625 | ||||||||
| Practice Location | |||||||||
| Address1: | 2213 BY PASS | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878408686 | ||||||||
| FaxNumber: | 7878408625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2016 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BONILLA | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GERENTE DE CONTRATACIONES Y COBROS | ||||||||
| AuthorizedOfficialTelephone: | 7878408686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 53 | PR | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.