MEDICARE: SOUTHERN ANESTHESIA ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	9957	PR

General Provider Information

NPI Number	:	1336120153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN ANESTHESIA ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 336030
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00733-6030
Country	:	US
Telephone Number	:	787-290-0135
Fax Number	:	787-284-8045

Provider Business Practice Location Address
First Line	:	2225 PONCE BY PASS
Second Line	:	EDIFICIO PARRA SUITE 404
City	:	PONCE
State	:	PR
Zip	:	00731-7779
Country	:	US
Telephone Number	:	787-284-5398
Fax Number	:	787-284-8045

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. MANUEL SANTIAGO CUMMINGS
Credential	:	M.D.
Telephone Number	:	787-284-5398

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	09/17/2015

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