Provider Demographics
NPI:1679959282
Name:LOUISIANA INTERNAL MEDICINE ASSOCIATES, LLC
Entity type:Organization
Organization Name:LOUISIANA INTERNAL MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-237-1645
Mailing Address - Street 1:13201 HWY 73
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734
Mailing Address - Country:US
Mailing Address - Phone:225-673-2088
Mailing Address - Fax:225-673-2080
Practice Address - Street 1:13201 HWY 73
Practice Address - Street 2:SUITE 102
Practice Address - City:GEISMAR
Practice Address - State:LA
Practice Address - Zip Code:70734
Practice Address - Country:US
Practice Address - Phone:225-673-2088
Practice Address - Fax:225-673-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty