Provider Demographics
NPI:1821458134
Name:JAMES C BUTLER
Entity Type:Organization
Organization Name:JAMES C BUTLER
Other - Org Name:LA HEART HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:LSRT
Authorized Official - Phone:985-646-3662
Mailing Address - Street 1:1150 ROBERT BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2004
Mailing Address - Country:US
Mailing Address - Phone:985-646-3662
Mailing Address - Fax:985-641-9281
Practice Address - Street 1:1150 ROBERT BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2005
Practice Address - Country:US
Practice Address - Phone:985-646-3662
Practice Address - Fax:985-641-9281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAHH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014621302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization