Healthcare Provider Details

I. General information

NPI: 1235510280
Provider Name (Legal Business Name): EVANGELINE CLINICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 POINCIANA AVE
MAMOU LA
70554-2243
US

IV. Provider business mailing address

80 VERSAILLES BLVD SUITE C
ALEXANDRIA LA
71303-3979
US

V. Phone/Fax

Practice location:
  • Phone: 337-468-5261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN WRIGHT
Title or Position: SVP GROUP OPERATIONS
Credential:
Phone: 318-561-7191