Provider Demographics
NPI:1063862340
Name:OSC ANESTHESIA, LLC
Entity Type:Organization
Organization Name:OSC ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:CRUEY
Authorized Official - Last Name:ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:318-212-0552
Mailing Address - Street 1:385 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:BLDG 300
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8158
Mailing Address - Country:US
Mailing Address - Phone:318-212-0552
Mailing Address - Fax:318-212-0557
Practice Address - Street 1:385 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:BLDG 300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8158
Practice Address - Country:US
Practice Address - Phone:318-212-0552
Practice Address - Fax:318-212-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.016818207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty