Provider Demographics
NPI:1689725772
Name:HEART & VASCULAR INSTITUTE OF LA LLC
Entity Type:Organization
Organization Name:HEART & VASCULAR INSTITUTE OF LA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-882-9800
Mailing Address - Street 1:PO BOX 740209
Mailing Address - Street 2:DEPT 1013
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0209
Mailing Address - Country:US
Mailing Address - Phone:985-882-9800
Mailing Address - Fax:985-882-9400
Practice Address - Street 1:64040 HIGHWAY 434
Practice Address - Street 2:SUITE 101
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-3499
Practice Address - Country:US
Practice Address - Phone:985-882-9800
Practice Address - Fax:985-882-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10048R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1022063Medicaid
LA1022063Medicaid