=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538169420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKIN CARE SPECIALISTS APMC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1051 GAUSE BLVD SUITE 460
-----------------------------------------------------
City | SLIDELL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70458-2951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-649-5880
-----------------------------------------------------
Fax | 985-649-5369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1051 GAUSE BLVD SUITE 460
-----------------------------------------------------
City | SLIDELL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70458-2951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-649-5880
-----------------------------------------------------
Fax | 985-649-5369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ELIZABETH I. MCBURNEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 985-649-5880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207NS0135X
-----------------------------------------------------
Taxonomy Name | Procedural Dermatology Physician
-----------------------------------------------------
License Number | 053107
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------