Basic Information
| Provider Information | |||||||||
| NPI: | 1568690139 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARISH ANESTHESIA ENDOSCOPY OF LAFAYETTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62600 DEPT 1491 | ||||||||
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| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701622600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047795515 | ||||||||
| FaxNumber: | 5047795568 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 COOLIDGE BLVD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372696062 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 07/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | STEVEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5047795515 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.