Healthcare Provider Details

I. General information

NPI: 1770307910
Provider Name (Legal Business Name): HSA LOUISIANA PHYSICIAN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MCMILLAN RD
WEST MONROE LA
71291-5327
US

IV. Provider business mailing address

503 MCMILLAN RD
WEST MONROE LA
71291-5327
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-4200
  • Fax:
Mailing address:
  • Phone: 318-329-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: AIMEE GILL
Title or Position: DEPUTY GENERAL COUNSEL
Credential:
Phone: 818-666-0602