Provider Demographics
NPI:1508997313
Name:PACER HEALTH MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:PACER HEALTH MANAGEMENT CORPORATION
Other - Org Name:SOUTH CAMERON MEMORIAL PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-439-8111
Mailing Address - Street 1:5360 W CREOLE HWY
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:LA
Mailing Address - Zip Code:70631-5127
Mailing Address - Country:US
Mailing Address - Phone:337-439-8111
Mailing Address - Fax:337-439-1970
Practice Address - Street 1:5360 W CREOLE HWY
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:LA
Practice Address - Zip Code:70631-5127
Practice Address - Country:US
Practice Address - Phone:337-439-8111
Practice Address - Fax:337-439-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA534146D00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1396727335OtherANEETA AFZAL M.D.
LA1306801634Medicare UPIN
LA1396727335OtherANEETA AFZAL M.D.