MEDICARE: MID CITY SPECIALTY CENTER, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1073026639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID CITY SPECIALTY CENTER, LLC

Provider Business Mailing Address
First Line	:	3600 FLORIDA BLVD STE 2000
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3842
Country	:	US
Telephone Number	:	225-381-6701
Fax Number	:	225-381-6702

Provider Business Practice Location Address
First Line	:	3600 FLORIDA BLVD STE 2000
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3842
Country	:	US
Telephone Number	:	225-381-6701
Fax Number	:	225-381-6702

Authorized Official
Title or Position	:	RCC
Name	:	HEATH VEULEMAN
Credential	:
Telephone Number	:	318-447-1598

Provider Enumeration Date	:	11/06/2017
Last Update Date	:	01/02/2018

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