Provider Demographics
NPI:1730278532
Name:MED EXPRESS OF CHAUVIN A MEDICAL LLC
Entity Type:Organization
Organization Name:MED EXPRESS OF CHAUVIN A MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:F
Authorized Official - Last Name:ABOU-ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-851-6680
Mailing Address - Street 1:5458 HIGHWAY 56
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHAUVIN
Mailing Address - State:LA
Mailing Address - Zip Code:70344-3102
Mailing Address - Country:US
Mailing Address - Phone:985-851-6680
Mailing Address - Fax:985-872-1420
Practice Address - Street 1:5458 HIGHWAY 56
Practice Address - Street 2:SUITE A
Practice Address - City:CHAUVIN
Practice Address - State:LA
Practice Address - Zip Code:70344-3102
Practice Address - Country:US
Practice Address - Phone:985-851-6680
Practice Address - Fax:985-872-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11737R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4A639Medicare ID - Type Unspecified
LAG41118Medicare UPIN