Basic Information
| Provider Information | |||||||||
| NPI: | 1891099388 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORD HEALTHCARE SERVICES, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 195041 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009195041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874484662 | ||||||||
| FaxNumber: | 7879980209 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 AVE ARTERIAL HOSTOS | ||||||||
| Address2: | APT. F- PH-1, COND. BAYSIDE COVE | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009182978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351001 | ||||||||
| FaxNumber: | 7879980209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2010 | ||||||||
| LastUpdateDate: | 12/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | RIOS DONES | ||||||||
| AuthorizedOfficialFirstName: | OTTO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7874484662 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 8758 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.