Provider Demographics
NPI:1609914373
Name:SOUTHWEST MISSISSIPPI ANESTHESIA
Entity Type:Organization
Organization Name:SOUTHWEST MISSISSIPPI ANESTHESIA
Other - Org Name:THE FELDMAN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-201-0950
Mailing Address - Street 1:505 E AIRPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6515
Mailing Address - Country:US
Mailing Address - Phone:225-201-0950
Mailing Address - Fax:225-923-3488
Practice Address - Street 1:505 E AIRPORT AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6515
Practice Address - Country:US
Practice Address - Phone:225-201-0950
Practice Address - Fax:225-923-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447374Medicaid
LA0495510002Medicare NSC
LA5CH38Medicare PIN