Healthcare Provider Details

I. General information

NPI: 1063596922
Provider Name (Legal Business Name): LOUISIANA HEALTHCARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71207 HIGHWAY 21
COVINGTON LA
70433-7121
US

IV. Provider business mailing address

13506 SUMMERPORT VILLAGE PKWY STE 739
WINDERMERE FL
34786-7366
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-6811
  • Fax: 985-892-8767
Mailing address:
  • Phone: 985-892-6811
  • Fax: 985-892-8767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number04588R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number022744
License Number StateLA

VIII. Authorized Official

Name: MR. VIJAY K. PUROHIT
Title or Position: PRESIDENT
Credential:
Phone: 407-284-1451