Provider Demographics
NPI:1316936974
Name:SURGICAL ANESTHESIA OF BATON ROUGE LLC
Entity type:Organization
Organization Name:SURGICAL ANESTHESIA OF BATON ROUGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIBAUDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-446-1417
Mailing Address - Street 1:PO BOX #204298
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-4298
Mailing Address - Country:US
Mailing Address - Phone:855-706-5542
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:1757 IMPERIAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5362
Practice Address - Country:US
Practice Address - Phone:855-706-5542
Practice Address - Fax:706-650-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444413Medicaid
LA5CE14Medicare PIN