Healthcare Provider Details

I. General information

NPI: 1346456605
Provider Name (Legal Business Name): MINDEN ANESTHESIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA PL
MINDEN LA
71055-3330
US

IV. Provider business mailing address

PO BOX 1278
SHREVEPORT LA
71163-1278
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-2321
  • Fax:
Mailing address:
  • Phone: 318-221-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number35526
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number47642
License Number StateLA

VIII. Authorized Official

Name: MR. LARRY HALEY
Title or Position: PARTNER
Credential: CRNA
Phone: 318-377-2321