Healthcare Provider Details

I. General information

NPI: 1942203476
Provider Name (Legal Business Name): SMH PROFESSIONAL SERV AT SMH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GAUSE BLVD
SLIDELL LA
70458-2939
US

IV. Provider business mailing address

120 INNWOOD DR
COVINGTON LA
70433-9123
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-2200
  • Fax:
Mailing address:
  • Phone: 985-892-3225
  • Fax: 985-234-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BILL DAVIS
Title or Position: CFO
Credential:
Phone: 985-649-8866