NPIMap

Organization Active NPI

Laboratorio Clinico Baco Stat-Lab II

  • Clinical Medical Laboratory
  • Mayaguez, PR
National Provider Identifier
1013036375
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
897 Issued in PR
Legal business name
LABORATORIO CLINICO BACO STAT-LAB II
Practice address
Carr 2, KM 149 HM 5, Bo Sabanetas Suite Num 15
Mayaguez, PR 00680-4821
Phone
(787) 832-0033
Fax
(787) 805-2045
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jorge B Baco Brogniez, B.S.M.T.(ASCP)GS
Title
President
Phone
(787) 429-2007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 897 PR Primary

Addresses

Primary practice location

Carr 2, KM 149 HM 5, Bo Sabanetas Suite Num 15
Mayaguez, PR 00680-4821

Mailing address

22 North Peral St
Mayaguez, PR 00680-4821
Phone (787) 832-7190

Other names 1

  • LABORATORIOS BACO INC. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080211000029 PR Part B Supplier - Independent Clinical Laboratory 6507949898 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mayaguez, PR

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Laboratorio Clinico Baco Stat - Labi3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1013036375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 NORTH PERAL ST",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "006804821",
            "telephone_number": "787-832-7190",
            "fax_number": "787-805-2045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 2, KM 149 HM 5, BO SABANETAS SUITE NUM 15",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "006804821",
            "telephone_number": "787-832-0033",
            "fax_number": "787-805-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO BACO STAT-LAB II",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "BACO BROGNIEZ",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-429-2007",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "B.S.M.T.(ASCP)GS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LABORATORIOS BACO INC.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mayaguez, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.