Healthcare Provider Details

I. General information

NPI: 1871118125
Provider Name (Legal Business Name): S WHEAT ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CLAYTON CT
SLIDELL LA
70461-5710
US

IV. Provider business mailing address

520 CLAYTON CT
SLIDELL LA
70461-5710
US

V. Phone/Fax

Practice location:
  • Phone: 985-326-6480
  • Fax:
Mailing address:
  • Phone: 985-326-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SCOTT G WHEAT SR.
Title or Position: OWNER
Credential: CRNA
Phone: 985-259-0619