MEDICARE: ST MARTIN PARISH GOVERNMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP0905X	State or Local Public Health Clinic/Center	1417238	LA

General Provider Information

NPI Number	:	1023110202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MARTIN PARISH GOVERNMENT

Provider Business Mailing Address
First Line	:	1555 GARY DRIVE
Second Line	:
City	:	BREAUX BRIDGE
State	:	LA
Zip	:	70517
Country	:	US
Telephone Number	:	337-332-2857
Fax Number	:	337-332-5745

Provider Business Practice Location Address
First Line	:	1555 GARY DR
Second Line	:
City	:	BREAUX BRIDGE
State	:	LA
Zip	:	70517-3448
Country	:	US
Telephone Number	:	337-332-2857
Fax Number	:	337-332-5745

Authorized Official
Title or Position	:	PARISH PRESIDENT
Name	:	GUY CORMIER
Credential	:
Telephone Number	:	337-332-2857

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/26/2011

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