Provider Demographics
NPI:1780879015
Name:JOSE E MERCED MD LLC
Entity type:Organization
Organization Name:JOSE E MERCED MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:EDGARDO
Authorized Official - Last Name:MERCED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-769-3002
Mailing Address - Street 1:PO BOX 81023
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-1023
Mailing Address - Country:US
Mailing Address - Phone:337-769-3002
Mailing Address - Fax:337-769-0309
Practice Address - Street 1:433 LA NEUVILLE RD
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5212
Practice Address - Country:US
Practice Address - Phone:337-769-3002
Practice Address - Fax:337-769-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021815261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1982491Medicaid
LA5U138Medicare PIN
LA1982491Medicaid
LA0043Medicare Oscar/Certification
LAF73519Medicare UPIN