1902957103 NPI number — LOUISIANA ANESTHESIOLOGY GROUP, L.L.C.

Table of content: DR. LEE TATE HAYMON DDS (NPI 1184751463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902957103 NPI number — LOUISIANA ANESTHESIOLOGY GROUP, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA ANESTHESIOLOGY GROUP, L.L.C.
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:
1902957103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2644 S SHERWOOD FRST STE 121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-2248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-293-2523
Provider Business Mailing Address Fax Number:
225-293-1807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WOMANS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70817-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-293-2523
Provider Business Practice Location Address Fax Number:
225-293-1807
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BATEMAN
Authorized Official First Name:
DEWITT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
225-293-2524

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1949353 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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