Provider Demographics
NPI:1225227556
Name:SUMMIT ANESTHESIA, INC.
Entity Type:Organization
Organization Name:SUMMIT ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BALDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-624-3470
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-0833
Mailing Address - Country:US
Mailing Address - Phone:985-624-3470
Mailing Address - Fax:
Practice Address - Street 1:106 RANDOM OAKS LN
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4565
Practice Address - Country:US
Practice Address - Phone:985-624-3470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08846R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1688550Medicaid
LAG39711Medicare UPIN