Provider Demographics
NPI:1699089581
Name:GASTROENTEROLOGY ANESTHESIA LLC
Entity type:Organization
Organization Name:GASTROENTEROLOGY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-345-6090
Mailing Address - Street 1:16061 DOCTORS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1499
Mailing Address - Country:US
Mailing Address - Phone:985-345-6090
Mailing Address - Fax:
Practice Address - Street 1:16061 DOCTORS BLVD STE A
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1499
Practice Address - Country:US
Practice Address - Phone:985-345-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty