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General NPI Number Information
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NPI Number | 1699293357
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Entity Type | Organization
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Legal Business Name | PERFUSION VASCULAR HAMMOND LLC
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 06/25/2021
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Provider Practice Location Address
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Address Line | 16065 LAMONTE DR
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City | HAMMOND
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State | LA
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Zip | 70403-1405
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Country | US
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Telephone | 985-892-7070
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Fax | 985-892-7017
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Provider Business Mailing Address
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Address Line | PO BOX 1089
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City | HAMMOND
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State | LA
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Zip | 70404-1089
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Country | US
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Telephone | 985-892-7070
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Fax | 985-892-7017
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Authorized Official
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Title or Position | CEO
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Name | SHAUN R CARPENTER
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Credential | MD
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Telephone | 985-892-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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