Healthcare Provider Details

I. General information

NPI: 1679157887
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF BAYOU REGION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 DUNN ST
HOUMA LA
70360-4704
US

IV. Provider business mailing address

PO BOX 6014
HOUMA LA
70361-6014
US

V. Phone/Fax

Practice location:
  • Phone: 985-873-1661
  • Fax:
Mailing address:
  • Phone: 985-873-4751
  • Fax: 985-873-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. FRANCES DIANE YEATES
Title or Position: COO
Credential:
Phone: 985-873-4751