Provider Demographics
NPI:1215174420
Name:ERIC J MELANCON M D LLC
Entity type:Organization
Organization Name:ERIC J MELANCON M D LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-384-7288
Mailing Address - Street 1:1151 MARGUERITE ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1151 MARGUERITE ST
Practice Address - Street 2:SUITE 200A
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1850
Practice Address - Country:US
Practice Address - Phone:985-384-7288
Practice Address - Fax:985-384-7291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIC J MELANCON MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1215174420Medicaid