Healthcare Provider Details

I. General information

NPI: 1639474257
Provider Name (Legal Business Name): C&M MEDICAL SERVICES-ST ELIZABETH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 WEST LOUISIANA HIGHWAY 30
GONZALES LA
70737
US

IV. Provider business mailing address

3223 8TH ST FLOOR 3
METAIRIE LA
70002-1623
US

V. Phone/Fax

Practice location:
  • Phone: 225-647-5000
  • Fax: 225-647-6066
Mailing address:
  • Phone: 504-833-7770
  • Fax: 504-833-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number017058
License Number StateLA

VIII. Authorized Official

Name: DR. CRIS MANDRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 504-833-7770