Provider Demographics
NPI: | 1942301379 |
---|---|
Name: | SOUTH LOUISIANA MEDICAL ASSOCIATES |
Entity Type: | Organization |
Organization Name: | SOUTH LOUISIANA MEDICAL ASSOCIATES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO/MEDICAL DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | GARCIA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 985-868-9300 |
Mailing Address - Street 1: | 1990 INDUSTRIAL BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUMA |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70363-7055 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 985-868-9300 |
Mailing Address - Fax: | 985-851-0053 |
Practice Address - Street 1: | 1990 INDUSTRIAL BLVD |
Practice Address - Street 2: | |
Practice Address - City: | HOUMA |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70363-7055 |
Practice Address - Country: | US |
Practice Address - Phone: | 985-868-9300 |
Practice Address - Fax: | 985-851-0053 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-26 |
Last Update Date: | 2017-02-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | 207L00000X, 207N00000X, 207P00000X, 207RC0000X, 207RE0101X, 207RN0300X, 207V00000X, 207W00000X, 207ZP0102X, 2084P0800X, 2085R0202X, 208600000X, 363AM0700X, 363LF0000X, 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
LA | 1792314 | Medicaid | |
LA | =========011 | Other | CHAMPUS |
LA | =========0 | Other | BC BS OF LA |
LA | =========0 | Other | BC BS OF LA |