Provider Demographics
NPI:1740699248
Name:ST ANNE ER GROUP, LLC
Entity type:Organization
Organization Name:ST ANNE ER GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:DEASE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:985-249-5600
Mailing Address - Street 1:229 SAINT JOHN LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3276
Mailing Address - Country:US
Mailing Address - Phone:985-773-1847
Mailing Address - Fax:985-249-5618
Practice Address - Street 1:4608 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2623
Practice Address - Country:US
Practice Address - Phone:985-537-6841
Practice Address - Fax:985-537-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty