Provider Demographics
NPI:1811934615
Name:PROFESSIONAL ANESTHESIA NETWORK, INC.
Entity type:Organization
Organization Name:PROFESSIONAL ANESTHESIA NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CRNA
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:318-335-3700
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-1105
Mailing Address - Country:US
Mailing Address - Phone:337-468-2767
Mailing Address - Fax:337-468-4170
Practice Address - Street 1:130 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-3035
Practice Address - Country:US
Practice Address - Phone:318-335-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02817367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty