Provider Demographics
NPI:1285817585
Name:GENERAL VASCULAR THORACIC SURGERY,L.L.C.
Entity Type:Organization
Organization Name:GENERAL VASCULAR THORACIC SURGERY,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-433-4651
Mailing Address - Street 1:641 S RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5726
Mailing Address - Country:US
Mailing Address - Phone:337-433-4651
Mailing Address - Fax:
Practice Address - Street 1:641 S. RYAN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-433-4651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013236208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty