Healthcare Provider Details

I. General information

NPI: 1710903059
Provider Name (Legal Business Name): C & M MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SEVERN AVE STE 205
METAIRIE LA
70001
US

IV. Provider business mailing address

2450 SEVERN AVE STE 205
METAIRIE LA
70001-1931
US

V. Phone/Fax

Practice location:
  • Phone: 504-833-7770
  • Fax: 504-833-7782
Mailing address:
  • Phone: 504-833-7770
  • Fax: 504-833-7782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMY D. PROVOST
Title or Position: AM
Credential:
Phone: 337-534-0952