Provider Demographics
NPI:1053945022
Name:DR SUSONI HEALTH COMMUNITY SERVICES CORP
Entity type:Organization
Organization Name:DR SUSONI HEALTH COMMUNITY SERVICES CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING AND COLLECTIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-650-7272
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0659
Mailing Address - Country:US
Mailing Address - Phone:787-650-7272
Mailing Address - Fax:787-650-7310
Practice Address - Street 1:CARR, 129 KM 1.0
Practice Address - Street 2:AVE SAN LUIS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613-0659
Practice Address - Country:US
Practice Address - Phone:787-650-7272
Practice Address - Fax:787-650-7310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR SUSONI HEALTH COMMUNITY SERVICES CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-27
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400087Medicaid