Healthcare Provider Details

I. General information

NPI: 1730823709
Provider Name (Legal Business Name): LOUISIANA CARDIOVASCULAR ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WILSON ST
LAFAYETTE LA
70503-2439
US

IV. Provider business mailing address

PO BOX 52327
LAFAYETTE LA
70505-2327
US

V. Phone/Fax

Practice location:
  • Phone: 337-806-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROCK BORDELON
Title or Position: OWNER
Credential:
Phone: 318-226-8202