Provider Demographics
NPI:1265623599
Name:ANESTHESIA ASSOCIATES OF LOUISIANA
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STIPELCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:985-223-3132
Mailing Address - Street 1:PO BOX 4333
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4333
Mailing Address - Country:US
Mailing Address - Phone:985-223-3132
Mailing Address - Fax:985-223-3126
Practice Address - Street 1:315 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4425
Practice Address - Country:US
Practice Address - Phone:985-223-3132
Practice Address - Fax:985-223-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD021195207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty