Provider Demographics
| NPI: | 1609969286 |
|---|---|
| Name: | MIGRANT HEALTH CENTER WESTERN REGION,INC |
| Entity type: | Organization |
| Organization Name: | MIGRANT HEALTH CENTER WESTERN REGION,INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTORA EJECUTIVA |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | TANIA |
| Authorized Official - Middle Name: | RODRIGUEZ |
| Authorized Official - Last Name: | MORALES |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 787-831-5800 |
| Mailing Address - Street 1: | PO BOX 190 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MAYAGUEZ |
| Mailing Address - State: | PR |
| Mailing Address - Zip Code: | 00681-0190 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 787-805-2920 |
| Mailing Address - Fax: | 787-834-1924 |
| Practice Address - Street 1: | CALLE RAMON EMETERIO BETANCES 497 |
| Practice Address - Street 2: | COND BLDG |
| Practice Address - City: | MAYAGUEZ |
| Practice Address - State: | PR |
| Practice Address - Zip Code: | 00680-1714 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 787-805-2900 |
| Practice Address - Fax: | 787-265-4245 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-10-02 |
| Last Update Date: | 2025-03-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 225X00000X, 235Z00000X, 261QD0000X, 261QD1600X, 261QF0400X, 261QM0801X, 261QM0850X, 261QM0855X, 261QM1300X, 261QR0200X, 261QR0206X, 261QR0207X, 291U00000X, 3336C0003X | ||
| PR | 06148 | 261QM1000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM1000X | Ambulatory Health Care Facilities | Clinic/Center | Migrant Health | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 261QR0200X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | |
| No | 261QR0206X | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography | |
| No | 261QR0207X | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile Mammography | |
| No | 291U00000X | Laboratories | Clinical Medical Laboratory | ||
| No | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PR | 037492808 | Medicaid | |
| PR | 039115304 | Medicaid | |
| PR | 0030983 | Medicare ID - Type Unspecified | MEDICARE LAB |
