Mayaguez Endocrine & Clinical Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

170 Issued in PR

Legal business name

MAYAGUEZ ENDOCRINE & CLINICAL LAB

Doing business as

Mayaguez Endocrine & Clinical Laboratory

Practice address

22 North Peral St
Mayaguez, PR 00680-4821

Phone

(787) 832-7190

Fax

(787) 805-2045

NPI assigned

May 24, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Jorge B Baco Broginiez, B.S.M.T.(ASCP)GS

Title

President

Phone

(787) 429-2007

Specialties & licenses 1

Addresses

Other names 2

• Mayaguez Endocrine & Clinical Laboratory Doing business as
• LABORATORIOS BACO INC. Other name

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

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

• Laboratorio Clinico Baco Stat - Labi

  • Clinical Medical Laboratory
  • Mayaguez, PR
  • NPI 1477675288

  O20080211000029

  Same enrollment
• Laboratorio Clinico Baco Stat-Lab II

  • Clinical Medical Laboratory
  • Mayaguez, PR
  • NPI 1013036375

  O20080211000029

  Same enrollment
• Laboratorios Baco Inc

  • Clinical Medical Laboratory
  • Mayaguez, PR
  • NPI 1932378585

  O20080211000029

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1114920956",
    "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": "22 NORTH PERAL ST",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "006804821",
            "telephone_number": "787-832-7190",
            "fax_number": "787-805-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYAGUEZ ENDOCRINE & CLINICAL LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "BACO BROGINIEZ",
        "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": "170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mayaguez Endocrine & Clinical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LABORATORIOS BACO INC.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mayaguez Advanced Radiotherapy Center
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• Mayaguez Ambulatory Surgical Center
• Mayaguez Center Drugstore Inc (Mayaguez Center Drug Store)
• Mayaguez Clinical Lab, Inc. (MAS Clinical Labs)
• Mayaguez Endodontics
• Mayaguez Health Clinic PHG
• Mayaguez Infusion Center Corp
• Mayaguez Medical Center - San Antonio Inc (Mayaguez Medical Center San Antonio)
• Mayaguez Medical Center Dr Ramon Emeterio Betances Inc

• Clinical Medical Laboratory in Mayaguez, PR
• Providers in Mayaguez, PR by specialty
• Clinical Medical Laboratory in Puerto Rico

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.