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NPI Code Detail

MEDICARE: AVALA PHYSICIAN NETWORK, LLC

MEDICARE: AVALA PHYSICIAN NETWORK, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician
2261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1922694710
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVALA PHYSICIAN NETWORK, LLC
Provider Business Mailing Address
First Line : 67252 INDUSTRY LN
Second Line :
City : COVINGTON
State : LA
Zip : 70433-8704
Country : US
Telephone Number : 985-888-1182
Fax Number :
Provider Business Practice Location Address
First Line : 1200 PINNACLE PKWY STE 3
Second Line :
City : COVINGTON
State : LA
Zip : 70433-9169
Country : US
Telephone Number : 985-674-1700
Fax Number : 985-674-1722
Authorized Official
Title or Position : CFO
Name : BROOKE CUMMINGS
Credential :
Telephone Number : 985-801-6247
Provider Enumeration Date : 12/15/2020
Last Update Date : 05/06/2026

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Directions to “AVALA PHYSICIAN NETWORK, LLC ” Practice Location

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