Healthcare Provider Details

I. General information

NPI: 1376708578
Provider Name (Legal Business Name): CARDIOLOGY CONSULTANTS OF LOUISIANA, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MAIN ST
FRANKLINTON LA
70438-3688
US

IV. Provider business mailing address

PO BOX 7010
METAIRIE LA
70010-7010
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-4102
  • Fax:
Mailing address:
  • Phone: 504-454-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN F JACOBS III
Title or Position: PARTNER
Credential: MD
Phone: 504-454-4120