Provider Demographics
NPI:1003479387
Name:LOUISIANA MEDSHIELD LLC
Entity Type:Organization
Organization Name:LOUISIANA MEDSHIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:PORCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-873-8586
Mailing Address - Street 1:430 CORPORATE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2514
Mailing Address - Country:US
Mailing Address - Phone:985-333-1421
Mailing Address - Fax:985-262-4651
Practice Address - Street 1:430 CORPORATE DR STE A
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2514
Practice Address - Country:US
Practice Address - Phone:985-333-1421
Practice Address - Fax:985-262-4651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty