Wilderness Medical Corp

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

15123 Issued in PR

Legal business name

WILDERNESS MEDICAL CORP

Practice address

14 Calle Pasarell
Bajos
Yauco, PR 00698

Phone

(787) 396-5183

NPI assigned

Oct 19, 2016

Organization subpart

No

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

Authorized official

Name

Pablo Decastro, M.D.NPI 1083838759

Title

Pressident

Phone

(787) 396-5183

Specialties & licenses 1

Addresses

Tax ID family

Wilderness Medical Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Wilderness Medical Corp

  • General Practice Physician
  • Ponce, PR
  • NPI 1760871792
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pablo Jose Decastro, M.D.

  • General Practice Physician
  • Ponce, PR
  • NPI 1083838759
  NPD (past) Authorized official

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478044800000",
    "number": "1487105045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 CALLE VEREDA",
            "address_2": "URB. VALLE VERDE",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007163515",
            "telephone_number": "787-396-5183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 CALLE PASARELL",
            "address_2": "BAJOS",
            "city": "YAUCO",
            "state": "PR",
            "postal_code": "00698",
            "telephone_number": "787-396-5183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDERNESS MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2016-11-02",
        "status": "A",
        "authorized_official_last_name": "DECASTRO",
        "authorized_official_first_name": "PABLO",
        "authorized_official_title_or_position": "PRESSIDENT",
        "authorized_official_telephone_number": "787-396-5183",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "PR",
            "license": "15123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara E Vicente, BS MT ASCP
• Gabriel Omar Vicenti Camacho
• Vidamed LLC
• Juan Carlos Villa, M.D.
• Walgreen Co.
• Harrington Wilkes Peralta, O.D.
• Yauco Health Clinic Inc
• Yauco Healthcare Corp
• Yauco Healthcare Corporation
• Yauco Healthcare Corporation

• Primary Care Clinic/Center in Yauco, PR
• Providers in Yauco, PR by specialty
• Primary Care Clinic/Center in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.