Healthcare Provider Details

I. General information

NPI: 1649617259
Provider Name (Legal Business Name): CAIN NEUROSURGERY CLINIC A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 WALNUT ST SUITE 110
MONROE LA
71201-6700
US

IV. Provider business mailing address

212 WALNUT ST SUITE 110
MONROE LA
71201-6700
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1809
  • Fax:
Mailing address:
  • Phone: 318-323-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD.205866
License Number StateLA

VIII. Authorized Official

Name: MRS. JAMIE CHAMBLESS
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-323-1809