Provider Demographics
NPI:1417474339
Name:ASCENSION MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ASCENSION MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVERGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-953-7388
Mailing Address - Street 1:37325 MARKET PLACE DR STE D
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3499
Mailing Address - Country:US
Mailing Address - Phone:225-953-7388
Mailing Address - Fax:225-953-7389
Practice Address - Street 1:37325 MARKET PLACE DR.
Practice Address - Street 2:SUITE D
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769
Practice Address - Country:US
Practice Address - Phone:225-953-7388
Practice Address - Fax:225-953-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2048762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1538182118OtherNPPES