Basic Information
| Provider Information | |||||||||
| NPI: | 1336301225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BYRON R HEBERTCRNA ANESTHESIA SRV INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8315 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705102248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378927634 | ||||||||
| FaxNumber: | 3378927634 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 N MAGDALEN SQ | ||||||||
| Address2: | YOUNG EYE SURGERY CENTER | ||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705104645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378927634 | ||||||||
| FaxNumber: | 3378927634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2008 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | HEBERT | ||||||||
| AuthorizedOfficialFirstName: | BYRON | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3378927634 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 037533 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1390631 | 05 | LA | MEDICAID |