Provider Demographics
NPI:1598886467
Name:CARDIOLOGY ASSOCIATES-A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES-A MEDICAL CORPORATION
Other - Org Name:CARDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VONGPHANET
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIHARATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-222-3695
Mailing Address - Street 1:1811 E BERT KOUNS
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115
Mailing Address - Country:US
Mailing Address - Phone:318-222-3695
Mailing Address - Fax:318-424-0717
Practice Address - Street 1:1811 E BERT KOUNS
Practice Address - Street 2:SUITE 100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115
Practice Address - Country:US
Practice Address - Phone:318-222-3695
Practice Address - Fax:318-424-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57879Medicare ID - Type UnspecifiedCARDIOLOGY ASSICATES