Healthcare Provider Details

I. General information

NPI: 1992827182
Provider Name (Legal Business Name): NATCHITOCHES ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KEYSER AVE
NATCHITOCHES LA
71457-6018
US

IV. Provider business mailing address

PO BOX 570
LAKE FOREST IL
60045-0570
US

V. Phone/Fax

Practice location:
  • Phone: 318-214-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES DAVID O'CON
Title or Position: OWNER
Credential: CRNA
Phone: 318-469-6650