Provider Demographics
NPI:1982108866
Name:SOUTHERN ENT ASSOCIATES INC
Entity Type:Organization
Organization Name:SOUTHERN ENT ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:R
Authorized Official - Last Name:TORTORICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-446-5079
Mailing Address - Street 1:604 N. ACADIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301
Mailing Address - Country:US
Mailing Address - Phone:985-446-5079
Mailing Address - Fax:877-795-9281
Practice Address - Street 1:604 N. ACADIA RD STE 101
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-446-5079
Practice Address - Fax:877-795-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09823363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty