Provider Demographics
NPI:1922240902
Name:PREMIER HEART CENTERS OF LA, LLC
Entity Type:Organization
Organization Name:PREMIER HEART CENTERS OF LA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ELIGO
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-735-8022
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70429-0578
Mailing Address - Country:US
Mailing Address - Phone:985-735-8022
Mailing Address - Fax:985-735-8024
Practice Address - Street 1:1407 AVENUE F
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4340
Practice Address - Country:US
Practice Address - Phone:985-735-8022
Practice Address - Fax:985-735-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.08620R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty