Provider Demographics
NPI:1881737104
Name:CARDIOTHORACIC SURGEONS OF THE SOUTH, LLC
Entity type:Organization
Organization Name:CARDIOTHORACIC SURGEONS OF THE SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MOUSSET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-439-5800
Mailing Address - Street 1:PO BOX 3084
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-3084
Mailing Address - Country:US
Mailing Address - Phone:337-436-7560
Mailing Address - Fax:337-433-9861
Practice Address - Street 1:1605 FOSTER ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5815
Practice Address - Country:US
Practice Address - Phone:337-439-5800
Practice Address - Fax:337-439-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15365R208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1175609Medicaid
LA5CJ24Medicare PIN
LADB0549Medicare PIN
LA1175609Medicaid