Provider Demographics
NPI:1811941487
Name:PCG MEDICAL,LLC
Entity type:Organization
Organization Name:PCG MEDICAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:504-836-3899
Mailing Address - Street 1:3350 RIDGELAKE DR
Mailing Address - Street 2:SUITE NUMBER 200
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3831
Mailing Address - Country:US
Mailing Address - Phone:504-836-3899
Mailing Address - Fax:504-836-3899
Practice Address - Street 1:3350 RIDGELAKE DR STE 280
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3873
Practice Address - Country:US
Practice Address - Phone:504-836-3899
Practice Address - Fax:504-836-3899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PCG MEDICAL REVOCABLE TRUST DATE AUGUST 3, 2005
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1529273Medicaid
LA5716060001Medicare NSC