Provider Demographics
NPI:1285117879
Name:PRECISION ANESTHESIA OF LAFAYETTE LLC
Entity type:Organization
Organization Name:PRECISION ANESTHESIA OF LAFAYETTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:337-519-6574
Mailing Address - Street 1:PO BOX 51182
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1182
Mailing Address - Country:US
Mailing Address - Phone:337-519-6574
Mailing Address - Fax:
Practice Address - Street 1:443 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2630
Practice Address - Country:US
Practice Address - Phone:337-269-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty