Basic Information
| Provider Information | |||||||||
| NPI: | 1922178599 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUNGS PROFESSIONAL SERVICES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | YPS ANESTHESIA SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4619 KENNY RD | ||||||||
| Address2: | YPS-CRED | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144578180 | ||||||||
| FaxNumber: | 6145833300 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 ANDRE ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NEW IBERIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705632159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373649225 | ||||||||
| FaxNumber: | 3373646094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 08/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5044424393 | ||||||||
| 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 | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 00C96U | 01 | TX | BCBSTX | OTHER | DP8370 | 01 | TX | MCR RR | OTHER | DF5538 | 01 | LA | RAILROAD MEDICARE | OTHER |