Provider Demographics
NPI:1164514774
Name:ANESTHESIOLOGY AND PAIN MANAGEMENT
Entity Type:Organization
Organization Name:ANESTHESIOLOGY AND PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUDARSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-752-7960
Mailing Address - Street 1:1666 E BERT KOUNS LOOP
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5714
Mailing Address - Country:US
Mailing Address - Phone:318-752-7960
Mailing Address - Fax:318-752-7880
Practice Address - Street 1:1666 E BERT KOUNS LOOP
Practice Address - Street 2:SUITE 125
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5714
Practice Address - Country:US
Practice Address - Phone:318-752-7960
Practice Address - Fax:318-752-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty