Healthcare Provider Details

I. General information

NPI: 1417712043
Provider Name (Legal Business Name): LOUISIANA VASCULAR LIMB SALVAGE AND CARDIOLOGY APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 06/04/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WILSON ST
LAFAYETTE LA
70503-2439
US

IV. Provider business mailing address

PO BOX 81427
LAFAYETTE LA
70598-1427
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-6523
  • Fax: 337-456-6521
Mailing address:
  • Phone: 337-456-6523
  • Fax: 337-456-6521

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: VICKIE D ABRAHAM
Title or Position: VP OPERATIONS
Credential:
Phone: 337-456-6523