Provider Demographics
NPI:1184991192
Name:SOUTHSHORE MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:SOUTHSHORE MEDICAL ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:504-779-5678
Mailing Address - Street 1:3939 HOUMA BLVD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2931
Mailing Address - Country:US
Mailing Address - Phone:504-779-5678
Mailing Address - Fax:
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:SUITE 228
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2931
Practice Address - Country:US
Practice Address - Phone:504-779-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10063R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty