=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356646715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZACHARY ASC PARTNERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2011
-----------------------------------------------------
Last Update Date | 01/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6550 MAIN ST STE 2600
-----------------------------------------------------
City | ZACHARY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70791-4092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-570-2804
-----------------------------------------------------
Fax | 225-654-0791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2421 CHURCH ST
-----------------------------------------------------
City | ZACHARY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70791-2710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-570-2804
-----------------------------------------------------
Fax | 225-654-0791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BARON J WILLIAMSON
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 225-570-2807
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | MD021383
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------