MEDICARE: GREATER BATON ROUGE ANESTHESIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366491417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER BATON ROUGE ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 1547
Second Line	:
City	:	SEDALIA
State	:	MO
Zip	:	65302-1547
Country	:	US
Telephone Number	:	660-826-5960
Fax Number	:	660-826-4852

Provider Business Practice Location Address
First Line	:	7855 HOWELL BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807
Country	:	US
Telephone Number	:	225-358-4900
Fax Number	:	225-358-4901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH COLE
Credential	:	MD
Telephone Number	:	225-358-4900

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	03/13/2008

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