Provider Demographics
NPI:1336120153
Name:SOUTHERN ANESTHESIA ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTHERN ANESTHESIA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:SANTIAGO
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-284-5398
Mailing Address - Street 1:PO BOX 336030
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-6030
Mailing Address - Country:US
Mailing Address - Phone:787-290-0135
Mailing Address - Fax:787-284-8045
Practice Address - Street 1:2225 PONCE BY PASS
Practice Address - Street 2:EDIFICIO PARRA SUITE 404
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731-7779
Practice Address - Country:US
Practice Address - Phone:787-284-5398
Practice Address - Fax:787-284-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0024116Medicare PIN