Organization
PONTCHARTRAIN ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY FOURCADE (CREDENTIALING/BILLING MANAGER)
(985) 781-8565
Entity
Organization
Contact information
Practice address
2781 CT SWITZER SR DR, SUITE 400, BILOXI, MS 39531
(228) 388-4585
Mailing address
75024 EMERYWOOD DR, ABITA SPRINGS, LA 70420-2700
(504) 231-3957
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2354779
—
LA
Enumeration date
03/11/2013
Last updated
08/03/2021
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