Provider Demographics
NPI:1326064742
Name:PROFESSIONAL ANESTHESIA SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:THEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-289-2966
Mailing Address - Street 1:PO BOX 53864
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3864
Mailing Address - Country:US
Mailing Address - Phone:337-289-2966
Mailing Address - Fax:337-289-2776
Practice Address - Street 1:611 SAINT LANDRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4627
Practice Address - Country:US
Practice Address - Phone:337-289-2966
Practice Address - Fax:337-289-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1794091Medicaid
LA1794091Medicaid
LAC01086Medicare PIN