Provider Demographics
NPI:1386858918
Name:KIDNEY CENTER OF SOUTH LOUISIANA, AMC
Entity type:Organization
Organization Name:KIDNEY CENTER OF SOUTH LOUISIANA, AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-446-0871
Mailing Address - Street 1:604 N. ACADIA RD.
Mailing Address - Street 2:SUITE 405
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301
Mailing Address - Country:US
Mailing Address - Phone:985-446-0871
Mailing Address - Fax:985-446-0874
Practice Address - Street 1:604 N. ACADIA RD.
Practice Address - Street 2:SUITE 405
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-446-0871
Practice Address - Fax:985-446-0874
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDNEY CENTER OF SOUTH LOUISIANA, AMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-10
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACH9035OtherRAILROAD MEDICARE
LACH9035OtherRAILROAD MEDICARE