Provider Demographics
NPI:1952697088
Name:SOUTH LOUISIANA FOOT & ANKLE, LLC
Entity Type:Organization
Organization Name:SOUTH LOUISIANA FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEONARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:985-385-2616
Mailing Address - Street 1:1302 LAKEWOOD DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1889
Mailing Address - Country:US
Mailing Address - Phone:985-385-2616
Mailing Address - Fax:985-385-2618
Practice Address - Street 1:1302 LAKEWOOD DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1889
Practice Address - Country:US
Practice Address - Phone:985-384-3338
Practice Address - Fax:985-385-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200026213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2165844Medicaid
LA2165844Medicaid