Provider Demographics
NPI:1396879490
Name:P. THOMAS CAUSEY, JR. MD AMC
Entity type:Organization
Organization Name:P. THOMAS CAUSEY, JR. MD AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERCY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-338-3525
Mailing Address - Street 1:102 THOMAS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7366
Mailing Address - Country:US
Mailing Address - Phone:318-338-3525
Mailing Address - Fax:318-338-3530
Practice Address - Street 1:102 THOMAS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7366
Practice Address - Country:US
Practice Address - Phone:318-338-3525
Practice Address - Fax:318-338-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020118207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADG1524OtherRR MEDICARE
LA1004588Medicaid
E41825Medicare UPIN
LADG1524OtherRR MEDICARE