Provider Demographics
NPI:1205888914
Name:MID-LOUISIANA ANESTHESIA CONSULTANTS, APMC
Entity type:Organization
Organization Name:MID-LOUISIANA ANESTHESIA CONSULTANTS, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-442-5399
Mailing Address - Street 1:P.O. BOX 5887
Mailing Address - Street 2:1444 PETERMAN DRIVE
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71307-5887
Mailing Address - Country:US
Mailing Address - Phone:318-442-5399
Mailing Address - Fax:318-442-1586
Practice Address - Street 1:1444 PETERMAN DRIVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-442-5399
Practice Address - Fax:318-442-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1941484Medicaid
LA57995Medicare UPIN