Provider Demographics
NPI:1891823829
Name:DPMLGSPRLA LLC
Entity Type:Organization
Organization Name:DPMLGSPRLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-635-6943
Mailing Address - Street 1:3901 HOUMA BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2930
Mailing Address - Country:US
Mailing Address - Phone:504-888-9403
Mailing Address - Fax:504-888-2895
Practice Address - Street 1:3901 HOUMA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2930
Practice Address - Country:US
Practice Address - Phone:504-888-9403
Practice Address - Fax:504-888-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM20007213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CU75Medicare ID - Type UnspecifiedGROUP NUMBER
LA5874300001Medicare NSC