Provider Demographics
NPI:1639373889
Name:AVOYELLES SURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL LLC
Entity Type:Organization
Organization Name:AVOYELLES SURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-253-7767
Mailing Address - Street 1:4239 HIGHWAY 1192
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-4771
Mailing Address - Country:US
Mailing Address - Phone:318-253-7767
Mailing Address - Fax:318-253-7756
Practice Address - Street 1:4239 HIGHWAY 1192
Practice Address - Street 2:SUITE 300
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-4711
Practice Address - Country:US
Practice Address - Phone:318-253-7767
Practice Address - Fax:318-253-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201214208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CY77Medicare PIN