Provider Demographics
NPI:1578737763
Name:CENTRAL LOUISIANA 'CENLA' NEUROLOGY LLC
Entity Type:Organization
Organization Name:CENTRAL LOUISIANA 'CENLA' NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:UGOKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-473-0773
Mailing Address - Street 1:PO BOX 12911
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2911
Mailing Address - Country:US
Mailing Address - Phone:318-473-0773
Mailing Address - Fax:318-473-0836
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:SUITE 311
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-473-0773
Practice Address - Fax:318-473-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13814R204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty