| Mr Dane Matthew Rodriguez, CRNA | |
|
6300 Main St, Zachary, LA 70791-4037 | |
| (225) 658-4337 | |
| (225) 658-4181 |
| Full Name | Mr Dane Matthew Rodriguez |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 6300 Main St, Zachary, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154690436 | NPI | - | NPPES |
| 2182081 | Medicaid | LA | |
| 07674505 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163W00000X | Registered Nurse | 121003 (Louisiana) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 1210036736 (Louisiana) | Primary |
| Entity Name | Ochsner Clinic Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1538151428 PECOS PAC ID: 8224933619 Enrollment ID: O20031126000513 |
| Entity Name | Total Anesthesia Care Stph Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669475190 PECOS PAC ID: 0749255909 Enrollment ID: O20040831000877 |
| Entity Name | Youngs Professional Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922178599 PECOS PAC ID: 2163524992 Enrollment ID: O20070226000608 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Dane Matthew Rodriguez, CRNA 8946 Interline Ave, Suite C, Baton Rouge, LA 70809-1913 Ph: (225) 923-0030 | Mr Dane Matthew Rodriguez, CRNA 6300 Main St, Zachary, LA 70791-4037 Ph: (225) 658-4337 |
Mr. Gerald Pedersen, C.R.N.A. Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 6300 Main St, Zachary, LA 70791 Phone: 225-658-4000 | |
James Chustz, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 6300 Main St, Zachary, LA 70791 Phone: 225-658-4000 Fax: 225-658-4274 | |
Frank Baxter Ragsdale, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 6300 Main St, Zachary, LA 70791 Phone: 225-658-4437 Fax: 225-658-4181 |