Provider Demographics
NPI:1295040350
Name:NORMANDY SURGICAL SUITE LLC
Entity Type:Organization
Organization Name:NORMANDY SURGICAL SUITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-898-2274
Mailing Address - Street 1:185 GREENBRIAR BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7234
Mailing Address - Country:US
Mailing Address - Phone:985-898-2274
Mailing Address - Fax:985-898-2010
Practice Address - Street 1:185 GREENBRIAR BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7234
Practice Address - Country:US
Practice Address - Phone:985-898-2274
Practice Address - Fax:985-898-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL020533261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical