Provider Demographics
NPI:1427523489
Name:SAMANTHA VIDRINE MD LLC
Entity type:Organization
Organization Name:SAMANTHA VIDRINE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDRINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-447-4280
Mailing Address - Street 1:1268 ATTAKAPAS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6515
Mailing Address - Country:US
Mailing Address - Phone:337-447-4280
Mailing Address - Fax:337-447-4282
Practice Address - Street 1:1268 ATTAKAPAS DR STE 102
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6515
Practice Address - Country:US
Practice Address - Phone:337-447-4280
Practice Address - Fax:337-447-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty