Provider Demographics
NPI:1477580637
Name:MID LOUISIANA SURGICAL SPECIALISTS
Entity Type:Organization
Organization Name:MID LOUISIANA SURGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MALEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-442-6767
Mailing Address - Street 1:3311 PRESCOTT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3983
Mailing Address - Country:US
Mailing Address - Phone:318-442-6767
Mailing Address - Fax:318-441-1359
Practice Address - Street 1:3311 PRESCOTT RD STE 201
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3983
Practice Address - Country:US
Practice Address - Phone:318-442-6767
Practice Address - Fax:318-441-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACK8221OtherRR MEDICARE
LA1444545Medicaid
LAG4276OtherBLUE CROSS GROUP
LA5CD82Medicare ID - Type UnspecifiedMEDICARE GROUP