Provider Demographics
NPI:1285677187
Name:ST. AMANT, SIDNEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:L
Last Name:ST. AMANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:225-664-2111
Mailing Address - Fax:225-664-2888
Practice Address - Street 1:28050 WALKER SOUTH RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-6047
Practice Address - Country:US
Practice Address - Phone:225-664-2111
Practice Address - Fax:225-664-2888
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016701207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA04866OtherBCBS
LA1328855Medicaid
LA04866OtherBCBS
LA1328855Medicaid
010037015Medicare PIN
5M579D086Medicare PIN
C04070Medicare PIN
LA5M759C822Medicare PIN
LA5M579CN33Medicare PIN
LA5D628Medicare PIN