Provider Demographics
NPI:1629142443
Name:ANESTHESIA ASSOCIATES OF LOUISA PSC
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF LOUISA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALAKLAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-638-4300
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-0903
Mailing Address - Country:US
Mailing Address - Phone:606-638-4300
Mailing Address - Fax:606-638-0039
Practice Address - Street 1:1057 MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9658
Practice Address - Country:US
Practice Address - Phone:606-638-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29892207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty