Provider Demographics
NPI:1053810770
Name:MEDCONNECTPR
Entity type:Organization
Organization Name:MEDCONNECTPR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-247-0595
Mailing Address - Street 1:16 CARRION CT
Mailing Address - Street 2:SUITE 62
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-247-0595
Mailing Address - Fax:
Practice Address - Street 1:1959 CALLE LOIZA STE 401
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1865
Practice Address - Country:US
Practice Address - Phone:787-247-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)