Provider Demographics
NPI:1184140154
Name:CARDIOVASCULAR SPECIALTY CARE CENTER OF COVINGTON, LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR SPECIALTY CARE CENTER OF COVINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-9878
Mailing Address - Street 1:2223 QUAIL RUN STE F
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9063
Mailing Address - Country:US
Mailing Address - Phone:225-456-5383
Mailing Address - Fax:225-615-7192
Practice Address - Street 1:71070 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7160
Practice Address - Country:US
Practice Address - Phone:225-456-5383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty