Healthcare Provider Details

I. General information

NPI: 1235536723
Provider Name (Legal Business Name): LMG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 WICHERS DR
MARRERO LA
70072-3002
US

IV. Provider business mailing address

4633 WICHERS DR
MARRERO LA
70072-3002
US

V. Phone/Fax

Practice location:
  • Phone: 504-391-7670
  • Fax: 504-378-9439
Mailing address:
  • Phone: 504-391-7670
  • Fax: 504-378-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANIEL J GALLAGHER
Title or Position: DIRECTOR
Credential: M.D,
Phone: 504-391-7670