Healthcare Provider Details

I. General information

NPI: 1063862340
Provider Name (Legal Business Name): OSC ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 IMPERIAL BLVD
LAKE CHARLES LA
70605-5362
US

IV. Provider business mailing address

PO BOX 4282
LAKE CHARLES LA
70606-4282
US

V. Phone/Fax

Practice location:
  • Phone: 337-312-1846
  • Fax: 337-310-1426
Mailing address:
  • Phone: 337-312-1846
  • Fax: 337-310-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.016818
License Number StateLA

VIII. Authorized Official

Name: CHRISTOPHER S JANIK
Title or Position: CFO
Credential:
Phone: 269-282-2172