Provider Demographics
NPI:1790738037
Name:SNIDER MEDICAL, L.L.C.
Entity Type:Organization
Organization Name:SNIDER MEDICAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-421-0090
Mailing Address - Street 1:1722 WESTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5743
Mailing Address - Country:US
Mailing Address - Phone:337-421-0090
Mailing Address - Fax:337-421-0015
Practice Address - Street 1:1722 WESTWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5743
Practice Address - Country:US
Practice Address - Phone:337-421-0090
Practice Address - Fax:337-421-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL019378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CS14Medicare ID - Type Unspecified