Provider Demographics
NPI:1467094268
Name:EXECUTIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:EXECUTIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-309-4600
Mailing Address - Street 1:701 POYDRAS ST STE 104
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70139-7761
Mailing Address - Country:US
Mailing Address - Phone:504-309-4600
Mailing Address - Fax:504-910-9200
Practice Address - Street 1:701 POYDRAS ST STE 104
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70139-7761
Practice Address - Country:US
Practice Address - Phone:504-309-4600
Practice Address - Fax:504-910-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty