Healthcare Provider Details

I. General information

NPI: 1184913378
Provider Name (Legal Business Name): HEART LUNG AND VASCULAR CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CHRISTIAN DR
RAYVILLE LA
71269-3658
US

IV. Provider business mailing address

244 SAINT ANDREWS RD
CALHOUN LA
71225-7931
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-1900
  • Fax: 318-329-1901
Mailing address:
  • Phone: 318-329-1900
  • Fax: 318-329-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number018916
License Number StateLA

VIII. Authorized Official

Name: BLAINE MCDERMOTT BORDERS
Title or Position: OWNER
Credential:
Phone: 318-329-1900