Provider Demographics
NPI:1942543400
Name:KJA ANESTHESIA LLC
Entity Type:Organization
Organization Name:KJA ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-241-6430
Mailing Address - Street 1:6438 PROVINCE LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3578
Mailing Address - Country:US
Mailing Address - Phone:225-241-6430
Mailing Address - Fax:
Practice Address - Street 1:6438 PROVINCE LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3578
Practice Address - Country:US
Practice Address - Phone:225-241-6430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025273207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4F361OtherMEDICARE
LAMD.025273OtherLA STATE BOARD OF MEDICAL EXAMINERS
LA1577758Medicaid