Provider Demographics
NPI:1669469748
Name:MEDICAL CENTER ANESTHESIOLOGISTS
Entity Type:Organization
Organization Name:MEDICAL CENTER ANESTHESIOLOGISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF ANESTHESIA- PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:DEAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-681-4440
Mailing Address - Street 1:1343 CANTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6079
Mailing Address - Country:US
Mailing Address - Phone:318-300-3643
Mailing Address - Fax:678-888-0390
Practice Address - Street 1:1 SAINT MARY PL
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4343
Practice Address - Country:US
Practice Address - Phone:318-681-4440
Practice Address - Fax:318-681-6862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC50853OtherMCR RAILROAD
LA1795241Medicaid
LA1795241Medicaid
LA1795241Medicaid