Provider Demographics
NPI:1619117363
Name:DR. SATYARTHI GUPTA & DR. SUSHMA GUPTA A PROFESSIONAL MEDICAL CORP.
Entity Type:Organization
Organization Name:DR. SATYARTHI GUPTA & DR. SUSHMA GUPTA A PROFESSIONAL MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-892-8660
Mailing Address - Street 1:108 HIGHLAND PARK PLAZA
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-892-8660
Mailing Address - Fax:985-892-0908
Practice Address - Street 1:108 HIGHLAND PARK PLAZA
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-892-8660
Practice Address - Fax:985-892-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center