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General NPI Number Information
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NPI Number | 1508548140
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR MEDICINE OF SLIDELL
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 2965 GAUSE BLVD E STE A
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City | SLIDELL
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State | LA
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Zip | 70461-4154
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Country | US
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Telephone | 985-503-7853
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Fax | 985-263-1771
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Provider Business Mailing Address
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Address Line | 2965 GAUSE BLVD E STE A
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City | SLIDELL
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State | LA
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Zip | 70461-4154
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Country | US
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Telephone | 985-503-7853
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Fax | 985-263-1771
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH GREGORY HICKEY
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Credential | MD, FACC
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Telephone | 504-250-6978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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