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General NPI Number Information
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NPI Number | 1164514774
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Entity Type | Organization
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Legal Business Name | ANESTHESIOLOGY AND PAIN MANAGEMENT
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 1666 E BERT KOUNS LOOP SUITE 125
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City | SHREVEPORT
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State | LA
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Zip | 71105-5714
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Country | US
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Telephone | 318-752-7960
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Fax | 318-752-7880
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Provider Business Mailing Address
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Address Line | 1666 E BERT KOUNS LOOP SUITE 125
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City | SHREVEPORT
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State | LA
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Zip | 71105-5714
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Country | US
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Telephone | 318-752-7960
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Fax | 318-752-7880
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Authorized Official
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Title or Position | CEO
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Name | SUDARSHAN TANGA
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Credential | MD
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Telephone | 318-752-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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