Healthcare Provider Details

I. General information

NPI: 1124075361
Provider Name (Legal Business Name): ST TAMMANY HEART & VASCULAR INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 STARBRUSH CIR
COVINGTON LA
70433-7208
US

IV. Provider business mailing address

PO BOX 62600 DEPT 1392
NEW ORLEANS LA
70162-2600
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-6020
  • Fax: 985-898-7907
Mailing address:
  • Phone: 985-871-6020
  • Fax: 985-871-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. FARHAD X ADULI
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 985-871-6020