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General NPI Number Information
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NPI Number | 1700465804
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Entity Type | Organization
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Legal Business Name | SUGARLAND MEDICAL SERVICES LLP
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 2912 JOHNSTON ST
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City | LAFAYETTE
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State | LA
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Zip | 70503-3246
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Country | US
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Telephone | 337-212-1846
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62982
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City | LAFAYETTE
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State | LA
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Zip | 70596-2982
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Country | US
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Telephone | 337-212-1846
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | JASON S COLLINS
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Credential | FNP-C
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Telephone | 337-212-1846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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