Provider Demographics
NPI:1609982651
Name:SURGICAL SPECIALISTS OF LA
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-234-3000
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-0129
Mailing Address - Country:US
Mailing Address - Phone:504-234-3000
Mailing Address - Fax:985-234-3002
Practice Address - Street 1:3100 GALLERIA DR STE 300
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2196
Practice Address - Country:US
Practice Address - Phone:504-934-3000
Practice Address - Fax:504-891-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA92030365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C851Medicare ID - Type Unspecified