Healthcare Provider Details

I. General information

NPI: 1417389313
Provider Name (Legal Business Name): COVINGTON CARDIOVASCULAR CARE AT ST. TAMMANY PARISH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 S HARRISON ST
COVINGTON LA
70433-3661
US

IV. Provider business mailing address

1202 S TYLER ST
COVINGTON LA
70433-2330
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-4140
  • Fax:
Mailing address:
  • Phone: 985-898-4000
  • Fax: 985-898-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATTI ELLISH
Title or Position: CEO
Credential:
Phone: 985-898-4410