1114310463 NPI number — CARDIAC CATH LAB OF ALEXANDRIA LP

Table of content: (NPI 1114310463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114310463 NPI number — CARDIAC CATH LAB OF ALEXANDRIA LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIAC CATH LAB OF ALEXANDRIA LP
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:
6
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:
1114310463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT #3023
Provider Second Line Business Mailing Address:
PO BOX 4417
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-644-8900
Provider Business Mailing Address Fax Number:
484-924-0053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 PECAN PARK AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71303-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-704-6182
Provider Business Practice Location Address Fax Number:
318-704-6183
Provider Enumeration Date:
03/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BEMIS
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
318-704-6182

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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