Healthcare Provider Details

I. General information

NPI: 1689997561
Provider Name (Legal Business Name): NORTHLAKE NEUROLOGICAL INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64301 HIGHWAY 434
LACOMBE LA
70445-5411
US

IV. Provider business mailing address

64301 HIGHWAY 434
LACOMBE LA
70445-5411
US

V. Phone/Fax

Practice location:
  • Phone: 985-882-4500
  • Fax:
Mailing address:
  • Phone: 985-882-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REX S HOUSER
Title or Position: AUTHORIZED MEMBER
Credential: MD
Phone: 985-882-4500