Provider Demographics
NPI:1144573676
Name:ASCENT MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:ASCENT MEDICAL GROUP, LLC
Other - Org Name:ASCENT MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NICAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-845-1825
Mailing Address - Street 1:612 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3346
Mailing Address - Country:US
Mailing Address - Phone:985-845-1825
Mailing Address - Fax:985-327-7112
Practice Address - Street 1:612 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3346
Practice Address - Country:US
Practice Address - Phone:985-845-1825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU51542Medicare UPIN
LA5T526Medicare PIN