Provider Demographics
NPI:1952389199
Name:HAYDEL SURGICAL CLINIC
Entity Type:Organization
Organization Name:HAYDEL SURGICAL CLINIC
Other - Org Name:HAYDEL, TEDESCO, MATHIEU, LEDOUX, APC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:HAYDEL
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-868-4890
Mailing Address - Street 1:502 BARROW ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4606
Mailing Address - Country:US
Mailing Address - Phone:985-868-4890
Mailing Address - Fax:985-876-7413
Practice Address - Street 1:502 BARROW ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4606
Practice Address - Country:US
Practice Address - Phone:985-868-4890
Practice Address - Fax:985-876-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1799530Medicaid
LA57392Medicare PIN