Provider Demographics
NPI:1588645303
Name:TCHEFUNCTE CARDIOVASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:TCHEFUNCTE CARDIOVASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LASALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-871-8227
Mailing Address - Street 1:101 E FAIRWAY DR
Mailing Address - Street 2:SUITE 504
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7503
Mailing Address - Country:US
Mailing Address - Phone:985-871-8227
Mailing Address - Fax:985-871-6920
Practice Address - Street 1:101 E FAIRWAY DR
Practice Address - Street 2:SUITE 504
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7503
Practice Address - Country:US
Practice Address - Phone:985-871-8227
Practice Address - Fax:985-871-6920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C356OtherMEDICARE I.D NUMBER
LA1948543Medicaid