Organization
PROFESSIONAL ANESTHESIA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT R THEARD MD (MANAGING MEMBER)
(337) 289-2966
Entity
Organization
Contact information
Practice address
611 SAINT LANDRY ST, LAFAYETTE, LA 70506-4627
(337) 289-2966
(337) 289-2776
Mailing address
PO BOX 53864, LAFAYETTE, LA 70505-3864
(337) 289-2966
(337) 289-2776
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1794091
—
LA
Enumeration date
07/15/2006
Last updated
03/28/2008
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