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General NPI Number Information
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NPI Number | 1407903651
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR CLINIC LLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 5000 AMBASSADOR CAFFERY PKWY PROVINCE BLDG. 14-A
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City | LAFAYETTE
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State | LA
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Zip | 70508-6984
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Country | US
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Telephone | 337-234-7779
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Fax | 337-235-7246
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Provider Business Mailing Address
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Address Line | 5000 AMBASSADOR CAFFERY PKWY PROVINCE BLDG. 14-A
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City | LAFAYETTE
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State | LA
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Zip | 70508-6984
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Country | US
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Telephone | 337-234-7779
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Fax | 337-235-7246
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ELAINE L MORROW
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Credential |
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Telephone | 337-234-7779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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