1295954212 NPI number — STAT ANESTHESIA INC

Table of content: (NPI 1295954212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295954212 NPI number — STAT ANESTHESIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAT ANESTHESIA INC
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:
1295954212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 TIFFANY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER RIDGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70123-1542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-737-6407
Provider Business Mailing Address Fax Number:
504-738-1912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 VETERANS MEMORIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002-5634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-455-1550
Provider Business Practice Location Address Fax Number:
504-455-2011
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLIFIELD
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
BOUGHTON
Authorized Official Title or Position:
OWNER CRNA
Authorized Official Telephone Number:
504-737-6407

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN029060 AP02166 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD6228 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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