Provider Demographics
NPI:1427561679
Name:ANGIOGENESIS MEDICAL LLC
Entity Type:Organization
Organization Name:ANGIOGENESIS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SCALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-364-2400
Mailing Address - Street 1:8032 SUMMA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3478
Mailing Address - Country:US
Mailing Address - Phone:225-364-2400
Mailing Address - Fax:
Practice Address - Street 1:8032 SUMMA AVE STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-364-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies