Provider Demographics
NPI:1548772957
Name:LOUISIANA INTERNAL MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LOUISIANA INTERNAL MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-237-1645
Mailing Address - Street 1:8490 PICARDY AVE STE 100B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3733
Mailing Address - Country:US
Mailing Address - Phone:225-381-6244
Mailing Address - Fax:225-381-6330
Practice Address - Street 1:4410 HIGHLAND RD STE A3
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4561
Practice Address - Country:US
Practice Address - Phone:225-831-4025
Practice Address - Fax:225-831-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care