Healthcare Provider Details

I. General information

NPI: 1356234660
Provider Name (Legal Business Name): RIDGE MICHAEL ARCENEAUX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 A JEFFERSON HIGHWAY ACADEMIC CENTER, 1ST FLOOR
JEFFERSON LA
70121
US

IV. Provider business mailing address

3922 COUNTRY DR
BOURG LA
70343-3602
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3260
  • Fax: 504-842-3193
Mailing address:
  • Phone: 985-720-6190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: