Healthcare Provider Details

I. General information

NPI: 1720623010
Provider Name (Legal Business Name): LSMD MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 CHEMIN METAIRIE RD
YOUNGSVILLE LA
70592-2000
US

IV. Provider business mailing address

107 MILTON ESTATES LN
YOUNGSVILLE LA
70592-6090
US

V. Phone/Fax

Practice location:
  • Phone: 337-351-5510
  • Fax:
Mailing address:
  • Phone: 337-351-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONIA L SYLVESTER
Title or Position: CLINICAL COORDINATOR
Credential:
Phone: 337-351-5510