Provider Demographics
NPI:1679798615
Name:LOUISIANA LAPAROENDOSCOPIC SURGICAL CLINIC INC
Entity Type:Organization
Organization Name:LOUISIANA LAPAROENDOSCOPIC SURGICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:NOREM
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:318-448-1040
Mailing Address - Street 1:301 4TH ST
Mailing Address - Street 2:PO BOX 30148
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8423
Mailing Address - Country:US
Mailing Address - Phone:318-448-1040
Mailing Address - Fax:318-448-0548
Practice Address - Street 1:301 4TH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8423
Practice Address - Country:US
Practice Address - Phone:318-448-1040
Practice Address - Fax:318-448-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1988782Medicaid
LA1988782Medicaid
LAF59734Medicare UPIN