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General NPI Number Information
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NPI Number | 1386838001
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Entity Type | Organization
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Legal Business Name | HOSPITAL MEDICAL TEAM, LLC
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 59355 RIVER WEST DR
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City | PLAQUEMINE
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State | LA
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Zip | 70764-6553
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Country | US
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Telephone | 225-776-0429
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Fax | 225-687-2556
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Provider Business Mailing Address
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Address Line | 25390 PECAN TREE LN
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City | PLAQUEMINE
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State | LA
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Zip | 70764-4524
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Country | US
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Telephone | 225-776-0429
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Fax | 225-687-2556
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARIA TERESA EVANGELISTA-DEAN
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Credential | M.D.
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Telephone | 225-776-0429
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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 | MD.200495
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License Number State | LA
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