Basic Information
| Provider Information | |||||||||
| NPI: | 1760968960 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT LUKES MEMORIAL HOSPITAL INC | ||||||||
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| OtherOrganizationName: | CENTRO DE SALUD FAMILIAR SAN LUCAS GO-GOGO | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 336810 | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007336810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878442080 | ||||||||
| FaxNumber: | 7878442090 | ||||||||
| Practice Location | |||||||||
| Address1: | URB INDUSTRIAL REPARADA 291 | ||||||||
| Address2: | B CALLE MONTERREY BO CANAS | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878442080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2018 | ||||||||
| LastUpdateDate: | 07/11/2018 | ||||||||
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| AuthorizedOfficialLastName: | REYES | ||||||||
| AuthorizedOfficialFirstName: | JULIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | EHR PROJECT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7878442080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT LUKES MEMORIAL HOSPITAL INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 147 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.