Provider Demographics
NPI:1750782025
Name:LAKE AREA ANESTHESIA INC
Entity type:Organization
Organization Name:LAKE AREA ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ELLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-540-6900
Mailing Address - Street 1:809 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-3321
Mailing Address - Country:US
Mailing Address - Phone:337-540-6900
Mailing Address - Fax:
Practice Address - Street 1:809 GARDEN LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-3321
Practice Address - Country:US
Practice Address - Phone:337-540-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty