Provider Demographics
NPI:1073627881
Name:HAMMOND CARDIOLOGY CLINIC
Entity type:Organization
Organization Name:HAMMOND CARDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:CPMM
Authorized Official - Phone:985-542-5972
Mailing Address - Street 1:16070 DOCTORS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1478
Mailing Address - Country:US
Mailing Address - Phone:985-542-5972
Mailing Address - Fax:985-318-3417
Practice Address - Street 1:16070 DOCTORS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1478
Practice Address - Country:US
Practice Address - Phone:985-542-5972
Practice Address - Fax:985-318-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207RC0000X207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1798517Medicaid
LA29134OtherBLUE CROSS CLINIC NUMBER
LACP2624OtherRAILROAD MEDICARE
LA29134OtherBLUE CROSS CLINIC NUMBER