Basic Information
| Provider Information | |||||||||
| NPI: | 1255399598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIOLOGY GROUP ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8212 SUMMA AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257694403 | ||||||||
| FaxNumber: | 2257693842 | ||||||||
| Practice Location | |||||||||
| Address1: | 8212 SUMMA AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257694403 | ||||||||
| FaxNumber: | 2257693842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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| AuthorizedOfficialLastName: | PISTO | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2257694403 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1174203 | 05 | LA | MEDICAID |