Healthcare Provider Details

I. General information

NPI: 1205127560
Provider Name (Legal Business Name): NES CENTRAL LOUISIANA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BOUNDARY AVE
WINNFIELD LA
71483-3427
US

IV. Provider business mailing address

PO BOX 504764
SAINT LOUIS MO
63150-4764
US

V. Phone/Fax

Practice location:
  • Phone: 318-648-3000
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-697-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SERGE MARTIAL
Title or Position: DIRECTOR
Credential:
Phone: 800-242-6711