Provider Demographics
NPI:1316575434
Name:SOUTHERN HEALTHCARE OF LOUISIANA
Entity Type:Organization
Organization Name:SOUTHERN HEALTHCARE OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HEINRICH
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:985-445-1345
Mailing Address - Street 1:1340 GAUSE BLVD W
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-5764
Mailing Address - Country:US
Mailing Address - Phone:985-445-1345
Mailing Address - Fax:985-400-3121
Practice Address - Street 1:1340 GAUSE BLVD W
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty