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General NPI Number Information
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NPI Number | 1457562738
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ELECTROPHYSIOLOGICAL MEDICAL SERVICES
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 29301 N. DIXIE RANCH RD.
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City | LACOMBE
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State | LA
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Zip | 70445-2290
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Country | US
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Telephone | 985-871-4114
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Fax | 985-871-4130
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Provider Business Mailing Address
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Address Line | 29301 N. DIXIE RANCH RD.
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City | LACOMBE
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State | LA
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Zip | 70445-2290
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Country | US
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Telephone | 985-871-4114
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Fax | 985-871-4130
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN LOGAN
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Credential | MD
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Telephone | 985-871-4114
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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 |
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License Number State |
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