Provider Demographics
NPI:1689825499
Name:LOUISIANA CARDIOVASCULAR AND LIMB SALVAGE CENTER, APMC
Entity Type:Organization
Organization Name:LOUISIANA CARDIOVASCULAR AND LIMB SALVAGE CENTER, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-456-6525
Mailing Address - Street 1:901 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2439
Mailing Address - Country:US
Mailing Address - Phone:337-456-6523
Mailing Address - Fax:337-456-6521
Practice Address - Street 1:4811 AMBASSADOR CAFFERY PARKWAY
Practice Address - Street 2:SUITE 401A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-456-6523
Practice Address - Fax:337-456-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD07649R208G00000X
LA208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1376060Medicaid
LAB89716Medicare UPIN
LA1376060Medicaid