Basic Information
| Provider Information | |||||||||
| NPI: | 1295732899 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPITAL EPISCOPAL SAN LUCAS | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HOSPITAL SAN LUCAS I | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 332027 | ||||||||
| Address2: | CALLE GUADALUPE FINAL #184 | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007332027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878404545 | ||||||||
| FaxNumber: | 7878410008 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 CALLE GUADALUPE | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007303561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878404545 | ||||||||
| FaxNumber: | 7878410008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CORA | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | JOAQUIN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7878404545 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MHSA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 54 | PR | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 10020 | 01 | PR | TRIPLE C | OTHER | 17020 | 01 | PR | TRIPLE S | OTHER | 92399 | 01 | PR | TRIPLE C PATHOLOGY | OTHER | 30048 | 01 | PR | UTI | OTHER | 2795 | 01 | PR | INTERNATIONAL MEDICAL CAR | OTHER | 30036 | 01 | PR | TRIPLE C AMBULATORY | OTHER | 18020 | 01 | PR | TRIPLE S | OTHER | 19020 | 01 | PR | TRIPLE C | OTHER | 300077 | 01 | PR | CRUZ AZUL | OTHER | 30794 | 01 | PR | TRIPLE C CATH | OTHER |