Provider Demographics
NPI:1255352902
Name:ANESTHESIA ASSOCIATES OF RUSTON LLC
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF RUSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:L
Authorized Official - Last Name:COX
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-251-3620
Mailing Address - Street 1:PO BOX 2048
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-2048
Mailing Address - Country:US
Mailing Address - Phone:318-251-3620
Mailing Address - Fax:318-255-6604
Practice Address - Street 1:925 NORTH TRENTON STREET
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-251-3620
Practice Address - Fax:318-255-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1337048Medicaid
LA437946305DOtherBLUE CROSS
LA437946305DOtherBLUE CROSS