Provider Demographics
NPI:1083984363
Name:ADVANCED MEDICAL SERVICES OF LOUISIANA LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SERVICES OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANTOINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:337-519-5323
Mailing Address - Street 1:PO BOX 11137
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-1137
Mailing Address - Country:US
Mailing Address - Phone:337-519-5323
Mailing Address - Fax:
Practice Address - Street 1:1417 CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6112
Practice Address - Country:US
Practice Address - Phone:337-519-5323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty