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General NPI Number Information
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NPI Number | 1487879094
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Entity Type | Organization
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Legal Business Name | CENLA UROLOGY CLINIC LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 06/04/2022
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Provider Practice Location Address
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Address Line | 3311 PRESCOTT RD STE 100
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3917
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Country | US
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Telephone | 318-442-3384
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Fax | 318-442-3385
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Provider Business Mailing Address
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Address Line | 3311 PRESCOTT RD SUITE 100
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3900
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Country | US
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Telephone | 318-442-3384
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Fax | 318-442-3385
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SUZANNE FAYE EDENS
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Credential |
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Telephone | 318-442-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | L009778
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License Number State | LA
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