MEDICARE: NORTH CADDO ANESTHESIA BILLING

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

General Provider Information

NPI Number	:	1518083187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CADDO ANESTHESIA BILLING

Provider Business Mailing Address
First Line	:	PO BOX 570
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-0570
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 S SPRUCE ST
Second Line	:
City	:	VIVIAN
State	:	LA
Zip	:	71082-3232
Country	:	US
Telephone Number	:	318-375-3235
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DAVID C JONES
Credential	:
Telephone Number	:	318-375-3235

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	10/29/2007

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Directions to “NORTH CADDO ANESTHESIA BILLING ” Practice Location

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