Provider Demographics
NPI:1073026639
Name:MID CITY SPECIALTY CENTER, LLC
Entity Type:Organization
Organization Name:MID CITY SPECIALTY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCC
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEULEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-447-1598
Mailing Address - Street 1:3600 FLORIDA BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3842
Mailing Address - Country:US
Mailing Address - Phone:225-381-6701
Mailing Address - Fax:225-381-6702
Practice Address - Street 1:3600 FLORIDA BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3842
Practice Address - Country:US
Practice Address - Phone:225-381-6701
Practice Address - Fax:225-381-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical