Provider Demographics
NPI:1730121294
Name:CARDIOVASCULAR ASSOCIATES, LLC.
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARESMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:985-871-0735
Mailing Address - Street 1:PO BOX 8987
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-8987
Mailing Address - Country:US
Mailing Address - Phone:985-871-0735
Mailing Address - Fax:985-892-1013
Practice Address - Street 1:141 LAKEVIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-871-0735
Practice Address - Fax:985-892-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441767Medicaid
LA1441767Medicaid