Provider Demographics
NPI:1811291859
Name:ROLSTON CARDIOVASCULAR ASSOCIATES, LLC
Entity type:Organization
Organization Name:ROLSTON CARDIOVASCULAR ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-454-9006
Mailing Address - Street 1:4224 HOUMA BLVD
Mailing Address - Street 2:SUITE 450A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2933
Mailing Address - Country:US
Mailing Address - Phone:504-454-9006
Mailing Address - Fax:504-454-5080
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 450A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-454-9006
Practice Address - Fax:504-454-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011699261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1191205Medicaid
LA1619952017OtherDR'S NPI
LA1191205Medicaid