Provider Demographics
NPI:1184178899
Name:LOUISIANA CARDIOVASCULAR AND NEPHROLOGY CENTER OF EXCELLENCE, LLC
Entity Type:Organization
Organization Name:LOUISIANA CARDIOVASCULAR AND NEPHROLOGY CENTER OF EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-220-3821
Mailing Address - Street 1:5300 BEE CAVES RD
Mailing Address - Street 2:BUILDING 3 - SUITE 100
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5226
Mailing Address - Country:US
Mailing Address - Phone:512-220-3821
Mailing Address - Fax:
Practice Address - Street 1:1418 HEATHER DR
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-7716
Practice Address - Country:US
Practice Address - Phone:512-220-3821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty