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General NPI Number Information
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NPI Number | 1245542661
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Entity Type | Organization
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Legal Business Name | INLAND CARDIOVASCULAR CLINIC
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 614 N 2ND ST
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City | MONROE
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State | LA
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Zip | 71201-6236
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Country | US
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Telephone | 318-330-9330
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Fax | 318-330-9517
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Provider Business Mailing Address
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Address Line | PO BOX 1711
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City | MONROE
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State | LA
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Zip | 71210-1711
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Country | US
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Telephone | 318-330-9330
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Fax | 318-330-9517
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Authorized Official
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Title or Position | NURSE
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Name | MRS. KIM L JOHNSON
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Credential |
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Telephone | 318-330-9330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 11738R
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License Number State | LA
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