Provider Demographics
NPI:1861444101
Name:SPIRES, STEPHEN R (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:SPIRES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 BOCAGE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2191
Mailing Address - Country:US
Mailing Address - Phone:318-419-0756
Mailing Address - Fax:337-392-4982
Practice Address - Street 1:815 S 10TH ST
Practice Address - Street 2:ELITE ANES. - CREDENTIALING
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4611
Practice Address - Country:US
Practice Address - Phone:337-392-5088
Practice Address - Fax:337-392-4982
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN099590-AP04371367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1861444101OtherBCBS OF LA
LA1177440Medicaid
LAP01032689OtherRR MEDICARE
LA1177440Medicaid