Provider Demographics
NPI:1336932334
Name:PROMOTORA MEDICA Y ODONTOLOGICA DE ANTIOQUIA S.A.
Entity type:Organization
Organization Name:PROMOTORA MEDICA Y ODONTOLOGICA DE ANTIOQUIA S.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:WILFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:604-322-1125
Mailing Address - Street 1:PO BOX 11597
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE 53 46 38 PISO 1, LA CANDELARIA
Practice Address - Street 2:
Practice Address - City:MEDELLIN
Practice Address - State:ANTIOQUIA
Practice Address - Zip Code:99999
Practice Address - Country:CO
Practice Address - Phone:604-322-1125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital