Provider Demographics
NPI:1336622158
Name:THE SURGERY CLINIC OF NORTHEAST LOUISIANA LLC
Entity Type:Organization
Organization Name:THE SURGERY CLINIC OF NORTHEAST LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SARTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-547-1959
Mailing Address - Street 1:1503 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1503 N 19TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4941
Practice Address - Country:US
Practice Address - Phone:318-547-1959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty