Provider Demographics
NPI:1194887489
Name:PACEMAKER CLINIC, INC.
Entity type:Organization
Organization Name:PACEMAKER CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUPLECHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-887-5927
Mailing Address - Street 1:4925 THRUSH ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-4443
Mailing Address - Country:US
Mailing Address - Phone:504-887-5927
Mailing Address - Fax:504-887-5981
Practice Address - Street 1:4925 THRUSH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-4443
Practice Address - Country:US
Practice Address - Phone:504-887-5927
Practice Address - Fax:504-887-5981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1166553Medicaid
LA1166553Medicaid