Healthcare Provider Details

I. General information

NPI: 1801817838
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 HIGHWAY 190 EAST SERVICE RD SUITE 200
COVINGTON LA
70433-4960
US

IV. Provider business mailing address

PO BOX 129
MADISONVILLE LA
70447-0129
US

V. Phone/Fax

Practice location:
  • Phone: 985-234-3000
  • Fax: 985-234-3002
Mailing address:
  • Phone: 985-234-3000
  • Fax: 985-234-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number92030365
License Number StateLA

VIII. Authorized Official

Name: MATTHEW S FRENCH
Title or Position: PRACTICE MANAGING PHYSICIAN
Credential: MD
Phone: 985-234-3000