Healthcare Provider Details

I. General information

NPI: 1689825499
Provider Name (Legal Business Name): LOUISIANA CARDIOVASCULAR AND LIMB SALVAGE CENTER, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 AMBASSADOR CAFFERY PARKWAY SUITE 401A
LAFAYETTE LA
70508
US

IV. Provider business mailing address

901 WILSON ST
LAFAYETTE LA
70503-2439
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 TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD07649R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: SAMUEL DAVID ABRAHAM
Title or Position: CFO
Credential:
Phone: 337-456-6525