Provider Demographics
NPI:1619290715
Name:DARCEY MEDICAL, LLC
Entity Type:Organization
Organization Name:DARCEY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DARCEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-542-2653
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1218
Mailing Address - Country:US
Mailing Address - Phone:985-542-2653
Mailing Address - Fax:985-662-0720
Practice Address - Street 1:20050 CRESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5207
Practice Address - Country:US
Practice Address - Phone:985-542-2653
Practice Address - Fax:985-662-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1216798Medicaid