Provider Demographics
NPI:1205925708
Name:CARDIOVASCULAR & INTERNAL MEDICINE ASSOCIATES, INC
Entity type:Organization
Organization Name:CARDIOVASCULAR & INTERNAL MEDICINE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-325-3812
Mailing Address - Street 1:200 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5359
Mailing Address - Country:US
Mailing Address - Phone:318-325-3812
Mailing Address - Fax:318-322-7319
Practice Address - Street 1:200 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5359
Practice Address - Country:US
Practice Address - Phone:318-325-3812
Practice Address - Fax:318-322-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CR0222OtherRAILROAD MEDICARE
LA=========0OtherBLUE CROSS
LA56758Medicare ID - Type UnspecifiedMEDICARE CLINIC NUMBER