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General NPI Number Information
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NPI Number | 1609914373
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Entity Type | Organization
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Legal Business Name | SOUTHWEST MISSISSIPPI ANESTHESIA
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 505 E AIRPORT AVE
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City | BATON ROUGE
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State | LA
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Zip | 70806-6515
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Country | US
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Telephone | 225-201-0950
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Fax | 225-923-3488
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Provider Business Mailing Address
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Address Line | 505 E AIRPORT AVE
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City | BATON ROUGE
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State | LA
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Zip | 70806-6515
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Country | US
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Telephone | 225-201-0950
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Fax | 225-923-3488
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BETH H BROADWAY
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Credential |
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Telephone | 225-201-0950
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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 |
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License Number State |
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