Basic Information
| Provider Information | |||||||||
| NPI: | 1356721294 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERA COLON SURGICAL SERVICES, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 659 | ||||||||
| Address2: | HOSPITAL PAVIA ARECIBO SUITE 101 | ||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507272 | ||||||||
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| Practice Location | |||||||||
| Address1: | CARR 129 KM 1.1 | ||||||||
| Address2: | HOSPITAL PAVIA ARECIBO SUITE 101 | ||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2015 | ||||||||
| LastUpdateDate: | 06/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | RIVERA COLON | ||||||||
| AuthorizedOfficialFirstName: | GUILLERMO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7874662961 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 18709 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | HW133A | 01 | PR | MEDICARE PTAN | OTHER |