Provider Demographics
NPI:1174618631
Name:ANESTHESIA MEDICAL GROUP PSCORP
Entity type:Organization
Organization Name:ANESTHESIA MEDICAL GROUP PSCORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:SANTOS BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-812-3318
Mailing Address - Street 1:8024 CALLE CONCORDIA STE 405
Mailing Address - Street 2:URB. SANTA MARIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1510
Mailing Address - Country:US
Mailing Address - Phone:787-812-3318
Mailing Address - Fax:787-290-3318
Practice Address - Street 1:8024 CALLE CONCORDIA STE 405
Practice Address - Street 2:URB. SANTA MARIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1510
Practice Address - Country:US
Practice Address - Phone:787-812-3318
Practice Address - Fax:787-290-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10892207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037440300Medicaid
PR0084518Medicare PIN
PR0084518AMedicare PIN