Provider Demographics
NPI:1104984293
Name:LOUISIANA CARDIOVASCULAR & THORACIC INSTITUTE, LLC
Entity type:Organization
Organization Name:LOUISIANA CARDIOVASCULAR & THORACIC INSTITUTE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-442-0106
Mailing Address - Street 1:3311 PRESCOTT RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3983
Mailing Address - Country:US
Mailing Address - Phone:318-442-0106
Mailing Address - Fax:318-448-8918
Practice Address - Street 1:3311 PRESCOTT RD STE 202
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3983
Practice Address - Country:US
Practice Address - Phone:318-442-0106
Practice Address - Fax:318-448-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444294Medicaid
LA5CE47Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER