Healthcare Provider Details

I. General information

NPI: 1982609483
Provider Name (Legal Business Name): CARDIOLOGY CONSULTANTS OF LOUISIANA, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOUMA BLVD FL 2
METAIRIE LA
70006-2970
US

IV. Provider business mailing address

PO BOX 7010
METAIRIE LA
70010-7010
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-4120
  • Fax: 504-454-4192
Mailing address:
  • Phone: 504-454-4120
  • Fax: 504-454-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. BENJAMIN F. JACOBS III
Title or Position: PARTNER
Credential: MD
Phone: 504-454-4120