MEDICARE: LOUISANA EM-I MEDICAL SERVICES A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1700399037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISANA EM-I MEDICAL SERVICES A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	13737 NOEL RD STE 1600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1374
Country	:	US
Telephone Number	:	469-401-2386
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 LOUISIANA AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-5921
Country	:	US
Telephone Number	:	469-401-2386
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	GREGORY J BYRNE
Credential	:
Telephone Number	:	214-712-2000

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	11/08/2017

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