Provider Demographics
NPI:1295991453
Name:FIRST HOSPITAL PANAMERICANO
Entity type:Organization
Organization Name:FIRST HOSPITAL PANAMERICANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-739-5555
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1400
Mailing Address - Country:US
Mailing Address - Phone:787-739-5555
Mailing Address - Fax:787-739-0035
Practice Address - Street 1:2213 PONCE BY PASS
Practice Address - Street 2:HOSPTIAL DAMAS 8VO PISO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1318
Practice Address - Country:US
Practice Address - Phone:787-842-0045
Practice Address - Fax:787-259-7536
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST HOSPITAL PANAMERICANO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97CNCNUM.911732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR404004Medicare PIN