Provider Demographics
NPI:1700465804
Name:SUGARLAND MEDICAL SERVICES LLP
Entity Type:Organization
Organization Name:SUGARLAND MEDICAL SERVICES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:337-212-1846
Mailing Address - Street 1:PO BOX 62982
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-2982
Mailing Address - Country:US
Mailing Address - Phone:337-212-1846
Mailing Address - Fax:
Practice Address - Street 1:2912 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3246
Practice Address - Country:US
Practice Address - Phone:337-212-1846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center