Healthcare Provider Details

I. General information

NPI: 1184178899
Provider Name (Legal Business Name): LOUISIANA CARDIOVASCULAR AND NEPHROLOGY CENTER OF EXCELLENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 HEATHER DR
OPELOUSAS LA
70570-7716
US

IV. Provider business mailing address

5300 BEE CAVES RD BUILDING 3 - SUITE 100
WEST LAKE HILLS TX
78746-5226
US

V. Phone/Fax

Practice location:
  • Phone: 512-220-3821
  • Fax:
Mailing address:
  • Phone: 512-220-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JARED LEGER
Title or Position: MANAGER
Credential:
Phone: 512-220-3821