Healthcare Provider Details

I. General information

NPI: 1366985806
Provider Name (Legal Business Name): SOUTH LOUISIANA MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 LAKEWOOD DR SUITE 202
MORGAN CITY LA
70380-1889
US

IV. Provider business mailing address

1990 INDUSTRIAL BLVD
HOUMA LA
70363-7055
US

V. Phone/Fax

Practice location:
  • Phone: 985-300-5438
  • Fax: 985-380-1029
Mailing address:
  • Phone: 985-868-9300
  • Fax: 985-851-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. MICHAEL J GARCIA
Title or Position: CEO/MEDICAL DIRECTOR
Credential: M.D.
Phone: 985-868-9300