Provider Demographics
NPI:1881887164
Name:SOUTH LOUISIANA RHEUMATOLOGY AND PAIN CLINIC, LLC
Entity type:Organization
Organization Name:SOUTH LOUISIANA RHEUMATOLOGY AND PAIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ELFERT
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-868-4333
Mailing Address - Street 1:459 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2462
Mailing Address - Country:US
Mailing Address - Phone:985-868-4333
Mailing Address - Fax:985-868-4390
Practice Address - Street 1:459 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2462
Practice Address - Country:US
Practice Address - Phone:985-868-4333
Practice Address - Fax:985-868-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5CD75Medicare PIN