Provider Demographics
NPI:1538113741
Name:SHELLY N SAVANT MD,LLC
Entity Type:Organization
Organization Name:SHELLY N SAVANT MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-639-8811
Mailing Address - Street 1:PO BOX 73701
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70033-3701
Mailing Address - Country:US
Mailing Address - Phone:985-639-8811
Mailing Address - Fax:985-781-1819
Practice Address - Street 1:1100 ANDRE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:337-365-6797
Practice Address - Fax:337-560-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025564174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1556360Medicaid
LA1556360Medicaid