Provider Demographics
NPI:1639474257
Name:C&M MEDICAL SERVICES-ST ELIZABETH LLC
Entity Type:Organization
Organization Name:C&M MEDICAL SERVICES-ST ELIZABETH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-833-7770
Mailing Address - Street 1:3223 8TH ST
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1623
Mailing Address - Country:US
Mailing Address - Phone:504-833-7770
Mailing Address - Fax:504-833-4025
Practice Address - Street 1:1125 WEST LOUISIANA HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-647-5000
Practice Address - Fax:225-647-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017058207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAJ3181OtherBC/BS OF LA