Provider Demographics
NPI:1982659744
Name:HEART CENTER OF CENTRAL LOUISIANA, L.P.
Entity Type:Organization
Organization Name:HEART CENTER OF CENTRAL LOUISIANA, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-448-6768
Mailing Address - Street 1:2108 TEXAS AVENUE
Mailing Address - Street 2:SUITE 2081
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-445-6559
Mailing Address - Fax:318-445-2914
Practice Address - Street 1:2108 TEXAS AVE
Practice Address - Street 2:SUITE 2081
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3944
Practice Address - Country:US
Practice Address - Phone:318-445-6559
Practice Address - Fax:318-445-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA754303002006261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C433Medicare PIN