Provider Demographics
NPI:1023003803
Name:SULPHUR SURGICAL CLINC
Entity Type:Organization
Organization Name:SULPHUR SURGICAL CLINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:SEALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-527-6363
Mailing Address - Street 1:914 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5107
Mailing Address - Country:US
Mailing Address - Phone:337-527-6363
Mailing Address - Fax:337-528-2168
Practice Address - Street 1:914 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5107
Practice Address - Country:US
Practice Address - Phone:337-527-6363
Practice Address - Fax:337-528-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6472864 001 0208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1157473Medicaid
LA1157473Medicaid