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General NPI Number Information
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NPI Number | 1407045792
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Entity Type | Organization
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Legal Business Name | LEESVILLE HEART CENTER PMC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 1106A PORT ARTHUR TER
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City | LEESVILLE
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State | LA
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Zip | 71446-4636
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Country | US
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Telephone | 337-392-1871
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Fax | 337-392-1804
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Provider Business Mailing Address
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Address Line | 1106A PORT ARTHUR TER
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City | LEESVILLE
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State | LA
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Zip | 71446-4636
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Country | US
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Telephone | 337-392-1871
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Fax | 337-392-1804
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REYMOND MEADAA
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Credential | M.D.
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Telephone | 337-392-1871
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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 | 11635R
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License Number State | LA
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