Basic Information
| Provider Information | |||||||||
| NPI: | 1295146678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LCS SURGICAL SERVICES PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 819 | ||||||||
| Address2: | |||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006810819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879517074 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 CALLE DR BASORA N | ||||||||
| Address2: | |||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006804833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878340101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 07/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | CARCORZE SOTO | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | DANIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7879517074 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 18625 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1689807968 | 01 | PR | NPI PERSONAL | OTHER | 18625 | 01 | PR | LICENCIA MEDICO PUERTO RICO | OTHER |