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General NPI Number Information
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NPI Number | 1669475190
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Entity Type | Organization
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Legal Business Name | TOTAL ANESTHESIA CARE STPH, LLC
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Dates
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Enumeration Date | 05/30/2005
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Last Update Date | 09/18/2020
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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 | 985-898-4000
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Fax |
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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 | COO & CFO
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Name | SHAN MCDANIEL AND SANDRA DIPIETRO
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Credential |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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