Provider Demographics
NPI:1376055897
Name:NORTHERN LOUISIANA CARDIAC SERVICES LLC
Entity Type:Organization
Organization Name:NORTHERN LOUISIANA CARDIAC SERVICES LLC
Other - Org Name:ADVANCED HEART AND VASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-681-5054
Mailing Address - Street 1:PO BOX 51008
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-1008
Mailing Address - Country:US
Mailing Address - Phone:318-629-3170
Mailing Address - Fax:
Practice Address - Street 1:1453 E BERT KOUNS INDUSTRIAL LOOP STE 220
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-6810
Practice Address - Country:US
Practice Address - Phone:318-629-3170
Practice Address - Fax:318-629-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical