=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548232416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREEDMAN MEMORIAL CARDIOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2006
-----------------------------------------------------
Last Update Date | 11/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3311 PRESCOTT RD SUITE 112
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-767-0960
-----------------------------------------------------
Fax | 318-767-0610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3311 PRESCOTT RD SUITE 112
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-767-0960
-----------------------------------------------------
Fax | 318-767-0610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/MANAGING PARTNER
-----------------------------------------------------
Name | ROBERT J. FREEDMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 318-767-0960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------