MEDICARE: HEART & VASCULAR INSTITUTE OF LA 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	207RC0000X	Cardiovascular Disease Physician	10048R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689725772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART & VASCULAR INSTITUTE OF LA LLC

Provider Business Mailing Address
First Line	:	PO BOX 740209
Second Line	:	DEPT 1013
City	:	ATLANTA
State	:	GA
Zip	:	30374-0209
Country	:	US
Telephone Number	:	985-882-9800
Fax Number	:	985-882-9400

Provider Business Practice Location Address
First Line	:	64040 HIGHWAY 434
Second Line	:	SUITE 101
City	:	LACOMBE
State	:	LA
Zip	:	70445-3499
Country	:	US
Telephone Number	:	985-882-9800
Fax Number	:	985-882-9400

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	PAUL E NATHAN
Credential	:	MD
Telephone Number	:	985-882-9800

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	06/26/2008

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Directions to “HEART & VASCULAR INSTITUTE OF LA LLC ” Practice Location

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