Provider Demographics
NPI:1811324742
Name:MATTHEW R COURVILLE MD LLC
Entity type:Organization
Organization Name:MATTHEW R COURVILLE MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:COURVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-738-3500
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648-0637
Mailing Address - Country:US
Mailing Address - Phone:337-738-3500
Mailing Address - Fax:337-335-0856
Practice Address - Street 1:208 6TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648-3186
Practice Address - Country:US
Practice Address - Phone:337-738-3500
Practice Address - Fax:337-335-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty