Provider Demographics
NPI:1144548512
Name:ELITE ANESTHESIA PROVIDERS, LLC
Entity type:Organization
Organization Name:ELITE ANESTHESIA PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARCANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:318-419-0756
Mailing Address - Street 1:6000 BOCAGE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2191
Mailing Address - Country:US
Mailing Address - Phone:318-419-0756
Mailing Address - Fax:337-392-4982
Practice Address - Street 1:815 S 10TH ST
Practice Address - Street 2:DOCTORS HOSPITAL @ DEER CREEK ANESTHESIOLOGY DEPT
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4611
Practice Address - Country:US
Practice Address - Phone:337-392-5088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2116908Medicaid
5DP07Medicare PIN