Healthcare Provider Details

I. General information

NPI: 1710036496
Provider Name (Legal Business Name): GLOBAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 OLD SPANISH TRL
SLIDELL LA
70458-3904
US

IV. Provider business mailing address

PO BOX 1896
SLIDELL LA
70459-1896
US

V. Phone/Fax

Practice location:
  • Phone: 985-641-4898
  • Fax: 985-641-8060
Mailing address:
  • Phone: 985-641-4898
  • Fax: 985-649-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1089
License Number StateLA

VIII. Authorized Official

Name: DENNIS M. PEYROUX
Title or Position: MEMBER
Credential: D.C.
Phone: 985-641-4898