MEDICARE: HEART CENTER OF CENTRAL LOUISIANA, L.P.

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	261QM2500X	Medical Specialty Clinic/Center	754303002006	LA

General Provider Information

NPI Number	:	1982659744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART CENTER OF CENTRAL LOUISIANA, L.P.

Provider Business Mailing Address
First Line	:	2108 TEXAS AVENUE
Second Line	:	SUITE 2081
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301
Country	:	US
Telephone Number	:	318-445-6559
Fax Number	:	318-445-2914

Provider Business Practice Location Address
First Line	:	2108 TEXAS AVE
Second Line	:	SUITE 2081
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3944
Country	:	US
Telephone Number	:	318-445-6559
Fax Number	:	318-445-2914

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOHN M HALL
Credential	:
Telephone Number	:	318-448-6768

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	04/20/2009

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