Provider Demographics
NPI:1649362740
Name:CHILDRENS HOSPITAL ANESTHESIA CORPORATION
Entity type:Organization
Organization Name:CHILDRENS HOSPITAL ANESTHESIA CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FG
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-214-8600
Mailing Address - Street 1:PO BOX 919211
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-9211
Mailing Address - Country:US
Mailing Address - Phone:504-613-0711
Mailing Address - Fax:678-248-9228
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:504-896-9456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1440868Medicaid
MS09015630Medicaid
LA5C970Medicare PIN