Healthcare Provider Details

I. General information

NPI: 1073627881
Provider Name (Legal Business Name): HAMMOND CARDIOLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16070 DOCTORS BLVD
HAMMOND LA
70403-1478
US

IV. Provider business mailing address

16070 DOCTORS BLVD
HAMMOND LA
70403-1478
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-5972
  • Fax: 985-318-3417
Mailing address:
  • Phone: 985-542-5972
  • Fax: 985-318-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number207RC0000X
License Number StateLA

VIII. Authorized Official

Name: MRS. LINDA Z KELLY
Title or Position: ADMINISTRATOR
Credential: CPMM
Phone: 985-542-5972