1689825499 NPI number — LOUISIANA CARDIOVASCULAR AND LIMB SALVAGE CENTER, APMC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689825499 NPI number — LOUISIANA CARDIOVASCULAR AND LIMB SALVAGE CENTER, APMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA CARDIOVASCULAR AND LIMB SALVAGE CENTER, APMC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689825499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 WILSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70503-2439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-456-6523
Provider Business Mailing Address Fax Number:
337-456-6521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4811 AMBASSADOR CAFFERY PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 401A
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-456-6523
Provider Business Practice Location Address Fax Number:
337-456-6521
Provider Enumeration Date:
10/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ABRAHAM
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
337-456-6525

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  MD07649R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1376060 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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