Provider Demographics
NPI:1730134636
Name:SMSO ANESTHESIA, LLC
Entity Type:Organization
Organization Name:SMSO ANESTHESIA, LLC
Other - Org Name:ALLI ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-998-7600
Mailing Address - Street 1:PO BOX 3185
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-3185
Mailing Address - Country:US
Mailing Address - Phone:318-812-1760
Mailing Address - Fax:318-812-1755
Practice Address - Street 1:101 CATALPA ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7418
Practice Address - Country:US
Practice Address - Phone:318-812-1760
Practice Address - Fax:318-812-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447056Medicaid
LA5CM62Medicare PIN