Healthcare Provider Details

I. General information

NPI: 1811934615
Provider Name (Legal Business Name): PROFESSIONAL ANESTHESIA NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL DR
OAKDALE LA
71463-3035
US

IV. Provider business mailing address

PO BOX 1105
OAKDALE LA
71463-1105
US

V. Phone/Fax

Practice location:
  • Phone: 318-335-3700
  • Fax:
Mailing address:
  • Phone: 337-468-2767
  • Fax: 337-468-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP02817
License Number StateLA

VIII. Authorized Official

Name: MR. KEITH A. ZIMMERMAN
Title or Position: OWNER/CRNA
Credential: CRNA
Phone: 318-335-3700