Provider Demographics
NPI:1275560567
Name:NORTHSHORE CARDIOVASCULAR ASSOCIATES LLC
Entity Type:Organization
Organization Name:NORTHSHORE CARDIOVASCULAR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-641-7283
Mailing Address - Street 1:2360 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4141
Mailing Address - Country:US
Mailing Address - Phone:985-641-7283
Mailing Address - Fax:985-641-7207
Practice Address - Street 1:2360 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4141
Practice Address - Country:US
Practice Address - Phone:985-641-7283
Practice Address - Fax:985-641-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1799661Medicaid
MS09012730Medicaid
LACD7049Medicare PIN
MSC00363Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MSCD7421Medicare UPIN
MS09012730Medicaid