Provider Demographics
NPI:1114189016
Name:CARDIOLOGY CONSULTANTS OF LOUISIANA A PROFESSIONAL MEDICAL CORPORATIO
Entity Type:Organization
Organization Name:CARDIOLOGY CONSULTANTS OF LOUISIANA A PROFESSIONAL MEDICAL CORPORATIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:504-454-4120
Mailing Address - Street 1:PO BOX 7010
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70010-7010
Mailing Address - Country:US
Mailing Address - Phone:504-454-4120
Mailing Address - Fax:
Practice Address - Street 1:1900 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3688
Practice Address - Country:US
Practice Address - Phone:504-454-4120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1794457Medicaid
MS9013677Medicare PIN
LA5D969Medicare PIN
LA57643Medicare PIN