Healthcare Provider Details

I. General information

NPI: 1669475935
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF OPELOUSAS, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 E PRUDHOMME ST
OPELOUSAS LA
70570-6499
US

IV. Provider business mailing address

PO BOX 459
OPELOUSAS LA
70571-0459
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-5120
  • Fax: 337-407-9645
Mailing address:
  • Phone: 337-948-5120
  • Fax: 337-407-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number019978
License Number StateLA

VIII. Authorized Official

Name: DR. ALBERT GROS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 337-948-5120