Healthcare Provider Details

I. General information

NPI: 1982649778
Provider Name (Legal Business Name): PEDIATRIC HEART CENTER A MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MEDICAL CENTER DR SUITE 4B
ALEXANDRIA LA
71301-8124
US

IV. Provider business mailing address

501 MEDICAL CENTER DR SUITE 4B
ALEXANDRIA LA
71301-8124
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-1508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LOUIS JOSEPH
Title or Position: VP
Credential:
Phone: 318-443-1508