Basic Information
| Provider Information | |||||||||
| NPI: | 1902957103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISIANA ANESTHESIOLOGY GROUP, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2644 S SHERWOOD FRST STE 121 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708162248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252932523 | ||||||||
| FaxNumber: | 2252931807 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WOMANS WAY | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708175100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252932523 | ||||||||
| FaxNumber: | 2252931807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | BATEMAN | ||||||||
| AuthorizedOfficialFirstName: | DEWITT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2252932524 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1949353 | 05 | LA | MEDICAID |