Provider Demographics
NPI:1992061709
Name:CENLA HEALTHCARE PHYSICAL MEDICINE
Entity type:Organization
Organization Name:CENLA HEALTHCARE PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-619-1112
Mailing Address - Street 1:3021 HIGHWAY 28 E
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5718
Mailing Address - Country:US
Mailing Address - Phone:318-619-1114
Mailing Address - Fax:318-619-1115
Practice Address - Street 1:3021 HIGHWAY 28 E
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5718
Practice Address - Country:US
Practice Address - Phone:318-619-1114
Practice Address - Fax:318-619-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1438111N00000X
LA204031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CY81Medicare UPIN