Basic Information
| Provider Information | |||||||||
| NPI: | 1235856253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL MENONITA PONCE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1650 | ||||||||
| Address2: | |||||||||
| City: | CIDRA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007391650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874341700 | ||||||||
| FaxNumber: | 7874341711 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR PR 506 KM 1.0 | ||||||||
| Address2: | BO COTO LAUREL | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007800000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874341700 | ||||||||
| FaxNumber: | 7874341711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2022 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | VAZQUEZ RIVERA | ||||||||
| AuthorizedOfficialFirstName: | LISSETTE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF COLLECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7874341700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 038390600 | 05 | PR | MEDICAID |