Healthcare Provider Details

I. General information

NPI: 1407903651
Provider Name (Legal Business Name): CARDIOVASCULAR CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AMBASSADOR CAFFERY PKWY PROVINCE BLDG. 14-A
LAFAYETTE LA
70508-6984
US

IV. Provider business mailing address

5000 AMBASSADOR CAFFERY PKWY PROVINCE BLDG. 14-A
LAFAYETTE LA
70508-6984
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-7779
  • Fax: 337-235-7246
Mailing address:
  • Phone: 337-234-7779
  • Fax: 337-235-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELAINE L MORROW
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-234-7779