Provider Demographics
NPI:1780639781
Name:LOUSTEAU & CECOLA AMC
Entity Type:Organization
Organization Name:LOUSTEAU & CECOLA AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOUSTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-821-0244
Mailing Address - Street 1:120 N JEFFERSON DAVIS PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5308
Mailing Address - Country:US
Mailing Address - Phone:504-821-0244
Mailing Address - Fax:504-821-0255
Practice Address - Street 1:120 N JEFFERSON DAVIS PKWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5308
Practice Address - Country:US
Practice Address - Phone:504-821-0244
Practice Address - Fax:504-821-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1794244Medicaid
LA1794244Medicaid