Provider Demographics
NPI:1215070503
Name:CARDIOVASCULAR AND THORACIC SURGEONS OF THE SOUTH, LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR AND THORACIC SURGEONS OF THE SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JULEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-373-7118
Mailing Address - Street 1:1431 OCHSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8110
Mailing Address - Country:US
Mailing Address - Phone:985-892-2950
Mailing Address - Fax:985-892-2980
Practice Address - Street 1:1431 OCHSNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8110
Practice Address - Country:US
Practice Address - Phone:985-892-2950
Practice Address - Fax:985-892-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9083R208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1660043Medicaid
LA5CE57Medicare PIN
LAE68464Medicare UPIN