Provider Demographics
NPI:1710166368
Name:LOUISIANA HEART HOSPITAL PROFFESION FEE, LLC
Entity Type:Organization
Organization Name:LOUISIANA HEART HOSPITAL PROFFESION FEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-690-7500
Mailing Address - Street 1:PO BOX 840596
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0596
Mailing Address - Country:US
Mailing Address - Phone:985-649-1152
Mailing Address - Fax:985-649-1217
Practice Address - Street 1:64030 LA HWY 434
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445
Practice Address - Country:US
Practice Address - Phone:985-649-1152
Practice Address - Fax:985-649-1217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA HEART HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-31
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0000000OtherMEDICARE PIN IS PENDING