Provider Demographics
NPI:1376716761
Name:CONSERVATIVE MEDICAL MANAGEMENT A
Entity Type:Organization
Organization Name:CONSERVATIVE MEDICAL MANAGEMENT A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MITZIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-6335
Mailing Address - Street 1:1103 KALISTE SALOOM RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5783
Mailing Address - Country:US
Mailing Address - Phone:337-269-6335
Mailing Address - Fax:337-235-2765
Practice Address - Street 1:1103 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5783
Practice Address - Country:US
Practice Address - Phone:337-269-6335
Practice Address - Fax:337-235-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL10009R207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1979732Medicaid
LA1979732Medicaid
LA5DD82Medicare PIN