Healthcare Provider Details

I. General information

NPI: 1598886467
Provider Name (Legal Business Name): CARDIOLOGY ASSOCIATES-A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 E BERT KOUNS SUITE 100
SHREVEPORT LA
71115
US

IV. Provider business mailing address

1811 E BERT KOUNS SUITE 100
SHREVEPORT LA
71115
US

V. Phone/Fax

Practice location:
  • Phone: 318-222-3695
  • Fax: 318-424-0717
Mailing address:
  • Phone: 318-222-3695
  • Fax: 318-424-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VONGPHANET J SIHARATH
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-222-3695