Provider Demographics
| NPI: | 1881083848 |
|---|---|
| Name: | VITAL-CARE MEDICAL CENTER L.L.C. |
| Entity type: | Organization |
| Organization Name: | VITAL-CARE MEDICAL CENTER L.L.C. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DAVID |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | AFANADOR |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 787-954-7777 |
| Mailing Address - Street 1: | PO BOX 399 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | AIBONITO |
| Mailing Address - State: | PR |
| Mailing Address - Zip Code: | 00705-0399 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 787-954-7777 |
| Mailing Address - Fax: | 787-535-9394 |
| Practice Address - Street 1: | CARRETERA 14 KM 49 |
| Practice Address - Street 2: | LAS DELICIAS |
| Practice Address - City: | AIBONITO |
| Practice Address - State: | PR |
| Practice Address - Zip Code: | 00705 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 787-954-7777 |
| Practice Address - Fax: | 787-535-9394 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2015-01-14 |
| Last Update Date: | 2024-10-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | Group - Multi-Specialty |
| No | 261QE0800X | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy | Group - Multi-Specialty |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PR | 037405000 | Medicaid |
