1033142807 NPI number — ALEXANDRIA CARDIOLOGY CLINIC

Table of content: (NPI 1033142807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033142807 NPI number — ALEXANDRIA CARDIOLOGY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEXANDRIA CARDIOLOGY CLINIC
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:
1033142807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 4TH ST # 30115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71301-8421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-473-4613
Provider Business Mailing Address Fax Number:
318-443-3400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-8124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-473-4613
Provider Business Practice Location Address Fax Number:
318-443-3400
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAIMAL
Authorized Official First Name:
PARAMESWARA
Authorized Official Middle Name:
KRISHNA
Authorized Official Title or Position:
PRESIDENT SENIOR PHYSICIAN
Authorized Official Telephone Number:
318-473-4613

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09015977 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1797065 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN9331 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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