Provider Demographics
NPI:1700029758
Name:L.A. ANESTHESIA LLC
Entity Type:Organization
Organization Name:L.A. ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:251-965-5393
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536-0137
Mailing Address - Country:US
Mailing Address - Phone:251-965-5393
Mailing Address - Fax:251-971-1029
Practice Address - Street 1:1613 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2247
Practice Address - Country:US
Practice Address - Phone:251-965-5393
Practice Address - Fax:251-971-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty