=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609982651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGICAL SPECIALISTS OF LA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 02/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 GALLERIA DR STE 300
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70001-2196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-934-3000
-----------------------------------------------------
Fax | 504-891-6660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 129
-----------------------------------------------------
City | MADISONVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70447-0129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-234-3000
-----------------------------------------------------
Fax | 985-234-3002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGING PHYSICIAN
-----------------------------------------------------
Name | MATTHEW S FRENCH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 985-234-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 92030365
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------