Provider Demographics
NPI:1215915202
Name:WESTERN LOUISIANA INTERNAL MEDICINE
Entity type:Organization
Organization Name:WESTERN LOUISIANA INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMANT
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-239-4130
Mailing Address - Street 1:1015 W FERTITTA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4646
Mailing Address - Country:US
Mailing Address - Phone:337-239-4130
Mailing Address - Fax:337-238-4104
Practice Address - Street 1:1015 W FERTITTA BLVD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4646
Practice Address - Country:US
Practice Address - Phone:337-239-4130
Practice Address - Fax:337-238-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14565R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA14565ROtherLA. STATE LICENSE #
LA1127647Medicaid
LA5CW22Medicare PIN
LA14565ROtherLA. STATE LICENSE #