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General NPI Number Information
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NPI Number | 1063415586
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Entity Type | Organization
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Legal Business Name | WEST ST. TAMMANY PARISH ANESTHESIA, INC APMC
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Dates
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Enumeration Date | 05/30/2005
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Last Update Date | 10/30/2009
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Provider Practice Location Address
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Address Line | 1202 S TYLER ST
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City | COVINGTON
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State | LA
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Zip | 70433-2330
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Country | US
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Telephone | 985-892-3225
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Fax | 985-234-0628
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Provider Business Mailing Address
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Address Line | 120 INNWOOD DR
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City | COVINGTON
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State | LA
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Zip | 70433-9123
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Country | US
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Telephone | 985-892-3225
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Fax | 985-234-0628
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAURICE WEILBAECHER
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Credential | M.D.
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Telephone | 985-892-3225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 016304
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License Number State | LA
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