Provider Demographics
NPI:1255881256
Name:SOUTHERN PAIN AND ANESHTESIA CONSULTANTS
Entity type:Organization
Organization Name:SOUTHERN PAIN AND ANESHTESIA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SINGLE MEMBER LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUBBELL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:504-887-7207
Mailing Address - Street 1:PO BOX 7725
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70010-7725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3348 W ESPLANADE AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3475
Practice Address - Country:US
Practice Address - Phone:504-887-7207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09618R207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5CC82Medicare UPIN