Provider Demographics
NPI:1063579456
Name:CENLA HEART SPECIALISTS LLC
Entity type:Organization
Organization Name:CENLA HEART SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-448-1041
Mailing Address - Street 1:2108 TEXAS AVE
Mailing Address - Street 2:SUITE 2061
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3944
Mailing Address - Country:US
Mailing Address - Phone:318-448-1041
Mailing Address - Fax:318-448-0865
Practice Address - Street 1:2108 TEXAS AVE
Practice Address - Street 2:SUITE 2061
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3944
Practice Address - Country:US
Practice Address - Phone:318-448-1041
Practice Address - Fax:318-448-0865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACJ8426OtherRAILROAD MEDICARE
LA1443336Medicaid
LA1443336Medicaid