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NPI Code Detail

MEDICARE: SMH PROFESSIONAL SERV AT SMH

MEDICARE: SMH PROFESSIONAL SERV AT SMH
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
1207RC0000XCardiovascular Disease Physician
2207LP2900XPain Medicine (Anesthesiology) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942203476
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMH PROFESSIONAL SERV AT SMH
Provider Business Mailing Address
First Line : 120 INNWOOD DR
Second Line :
City : COVINGTON
State : LA
Zip : 70433-9123
Country : US
Telephone Number : 985-892-3225
Fax Number : 985-234-0628
Provider Business Practice Location Address
First Line : 1001 GAUSE BLVD
Second Line :
City : SLIDELL
State : LA
Zip : 70458-2939
Country : US
Telephone Number : 985-643-2200
Fax Number :
Authorized Official
Title or Position : CFO
Name : BILL DAVIS
Credential :
Telephone Number : 985-649-8866
Provider Enumeration Date : 05/30/2005
Last Update Date : 09/21/2009

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Directions to “SMH PROFESSIONAL SERV AT SMH ” Practice Location

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