Provider Demographics
NPI:1154486355
Name:ST TAMMANY ANESTHESIA GROUP
Entity Type:Organization
Organization Name:ST TAMMANY ANESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD ANESTHESIALOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KERMIT
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-309-4211
Mailing Address - Street 1:PO BOX 113327
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011
Mailing Address - Country:US
Mailing Address - Phone:504-309-4211
Mailing Address - Fax:504-309-4214
Practice Address - Street 1:4324 VETERANS BLVD
Practice Address - Street 2:EYECARE ASSOCIATES
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-455-4046
Practice Address - Fax:504-455-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445363Medicaid
B65735Medicare UPIN
LA1445363Medicaid