Organization
RIVERSIDE ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND R (RUSTY) SMITH CRNA (DIRECTOR)
(318) 336-2220
Entity
Organization
Contact information
Practice address
241 AIMEE RD, FERRIDAY, LA 71334-9615
(318) 336-2220
(318) 336-6060
Mailing address
241 AIMEE RD, FERRIDAY, LA 71334-9615
(318) 336-2220
(318) 336-6060
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04321278
—
MS
05
—
1447561
—
KY
Enumeration date
05/15/2006
Last updated
10/04/2007
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