Provider Demographics
NPI:1538193719
Name:SOUTH LOUISIANA ANESTHESIOLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:SOUTH LOUISIANA ANESTHESIOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-367-2812
Mailing Address - Street 1:600 JEFFERSON ST
Mailing Address - Street 2:STE 301
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6942
Mailing Address - Country:US
Mailing Address - Phone:337-367-2812
Mailing Address - Fax:337-369-3536
Practice Address - Street 1:2315 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4031
Practice Address - Country:US
Practice Address - Phone:337-367-2812
Practice Address - Fax:337-369-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1799076Medicaid
LA1799076Medicaid
LA5B718Medicare PIN