1295711075 NPI number — FRONT SIGHT ANESTHESIA, PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295711075 NPI number — FRONT SIGHT ANESTHESIA, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONT SIGHT ANESTHESIA, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295711075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250435
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00604-0435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-907-0870
Provider Business Mailing Address Fax Number:
787-997-0870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR #2 KM 129.3 BO VICTORIA
Provider Second Line Business Practice Location Address:
OFICINA #13 AGUADILLA MEDICAL SERVICES
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-997-0870
Provider Business Practice Location Address Fax Number:
787-997-0870
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JIMENEZ
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
RAMON
Authorized Official Title or Position:
PRESIDENT / OWNER
Authorized Official Telephone Number:
787-640-1234

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  10854 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 601138 . This is a "MEDICARE Y MUCHO MAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6050002 . This is a "HUMANA INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0510807 . This is a "ACAA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1086 . This is a "PREFERRED MEDOCARE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200232 . This is a "HUMANA REFORMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 581633650 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6050037 . This is a "HUMANA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: AN81778 . This is a "UIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061348 . This is a "CRUZ AZUL DE PR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90437 . This is a "SSS SSS REFORMA SSS OPTIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "COSVI MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208062 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PE3949 . This is a "PANAMERICAN LIFE INSURANC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 581633650 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2534 . This is a "AMERICAN HEALTH" identifier . This identifiers is of the category "OTHER".




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