Provider Demographics
NPI:1467776088
Name:ORLEANS CARDIOVASCULAR ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ORLEANS CARDIOVASCULAR ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-469-3813
Mailing Address - Street 1:2820 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6302
Mailing Address - Country:US
Mailing Address - Phone:504-821-8158
Mailing Address - Fax:504-304-1927
Practice Address - Street 1:2820 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6302
Practice Address - Country:US
Practice Address - Phone:504-821-8158
Practice Address - Fax:504-304-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPENDINGMedicare Oscar/Certification