Healthcare Provider Details

I. General information

NPI: 1841287901
Provider Name (Legal Business Name): ANESTHESIOLOGY & PAIN CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 KALISTE SALOOM RD SUITE 304
LAFAYETTE LA
70508-5783
US

IV. Provider business mailing address

1103 KALISTE SALOOM RD SUITE 304
LAFAYETTE LA
70508-5783
US

V. Phone/Fax

Practice location:
  • Phone: 337-988-5646
  • Fax: 337-988-4298
Mailing address:
  • Phone: 337-988-5646
  • Fax: 337-988-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CRYSTAL BROUSSARD
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 337-706-1545