Healthcare Provider Details

I. General information

NPI: 1326342064
Provider Name (Legal Business Name): ACCESS HEALTH LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 MILLING AVE
LULING LA
70070-4442
US

IV. Provider business mailing address

843 MILLING AVE
LULING LA
70070-4442
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-5800
  • Fax: 985-785-5811
Mailing address:
  • Phone: 985-785-5800
  • Fax: 985-785-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD04201R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.04201R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD.03945R
License Number StateLA

VIII. Authorized Official

Name: TRENTON BUSSEY
Title or Position: CFO
Credential:
Phone: 985-785-5800