Healthcare Provider Details

I. General information

NPI: 1356646715
Provider Name (Legal Business Name): ZACHARY ASC PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 MAIN ST STE 2600
ZACHARY LA
70791-4092
US

IV. Provider business mailing address

2421 CHURCH ST
ZACHARY LA
70791-2710
US

V. Phone/Fax

Practice location:
  • Phone: 225-570-2804
  • Fax: 225-654-0791
Mailing address:
  • Phone: 225-570-2804
  • Fax: 225-654-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberMD021383
License Number StateLA

VIII. Authorized Official

Name: DR. BARON J WILLIAMSON
Title or Position: OWNER
Credential: M. D.
Phone: 225-570-2807