Provider Demographics
NPI:1306949185
Name:NORTHLAKE ANESTHESIOLOGISTS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NORTHLAKE ANESTHESIOLOGISTS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SCURRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-717-5387
Mailing Address - Street 1:636 GAUSE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2007
Mailing Address - Country:US
Mailing Address - Phone:985-649-4063
Mailing Address - Fax:985-649-2833
Practice Address - Street 1:636 GAUSE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2007
Practice Address - Country:US
Practice Address - Phone:985-649-4063
Practice Address - Fax:985-649-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1796450Medicaid
LA26676OtherBLUE CROSS
LA56676Medicare ID - Type UnspecifiedMEDICARE