Provider Demographics
NPI:1780624585
Name:CARDIOVASCULAR CONSULTANTS, LLP
Entity type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEASON
Authorized Official - Suffix:
Authorized Official - Credentials:FACMPE
Authorized Official - Phone:318-631-6400
Mailing Address - Street 1:2727 HEARNE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2727 HEARNE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3931
Practice Address - Country:US
Practice Address - Phone:318-631-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1946265Medicaid
LA1946265Medicaid