Healthcare Provider Details

I. General information

NPI: 1245880541
Provider Name (Legal Business Name): PENNINGTON ANESTHESIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 SUMMA AVE
BATON ROUGE LA
70809-3720
US

IV. Provider business mailing address

PO BOX 660257
BIRMINGHAM AL
35266-0257
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-4493
  • Fax:
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN PENNINGTON
Title or Position: PRESIDENT
Credential: CRNA
Phone: 225-328-5882