Provider Demographics
NPI:1295711075
Name:FRONT SIGHT ANESTHESIA, PSC
Entity type:Organization
Organization Name:FRONT SIGHT ANESTHESIA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-640-1234
Mailing Address - Street 1:PO BOX 250435
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0435
Mailing Address - Country:US
Mailing Address - Phone:787-907-0870
Mailing Address - Fax:787-997-0870
Practice Address - Street 1:CARR #2 KM 129.3 BO VICTORIA
Practice Address - Street 2:OFICINA #13 AGUADILLA MEDICAL SERVICES
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-997-0870
Practice Address - Fax:787-997-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10854207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
601138OtherMEDICARE Y MUCHO MAS
6050002OtherHUMANA INSURANCE
0510807OtherACAA
1086OtherPREFERRED MEDOCARE CHOICE
200232OtherHUMANA REFORMA
PR581633650Medicaid
6050037OtherHUMANA HEALTH PLANS
AN81778OtherUIA
061348OtherCRUZ AZUL DE PR
90437OtherSSS SSS REFORMA SSS OPTIM
=========OtherCOSVI MED
208062OtherPREFERRED HEALTH
PE3949OtherPANAMERICAN LIFE INSURANC
581633650OtherAETNA
2534OtherAMERICAN HEALTH