MEDICARE: HEALOGICS SPECIALTY PHYSICIANS OF LOUISIANA, 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	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1134528623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALOGICS SPECIALTY PHYSICIANS OF LOUISIANA, LLC

Provider Business Mailing Address
First Line	:	5220 BELFORT RD
Second Line	:	SUITE 130
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 OAK PARK BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8900
Country	:	US
Telephone Number	:	904-446-3017
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FRANK WILLIAMS
Credential	:
Telephone Number	:	904-446-3519

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	06/01/2023

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