Basic Information
| Provider Information | |||||||||
| NPI: | 1649700535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRUPO HOSPITALISTAS SAN JORGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6308 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009146308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872833476 | ||||||||
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| Practice Location | |||||||||
| Address1: | 258 CALLE SAN JORGE | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877271000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 06/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ | ||||||||
| AuthorizedOfficialFirstName: | MURIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING COMPANY | ||||||||
| AuthorizedOfficialTelephone: | 7876323445 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAN JORGE CHILDREN'S HOSPITAL, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.