| Organization Name: | ASCENSION MEDICAL CLINIC, LLC |
| NPI Number: | 1104084938 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN L HOLMES (GENERAL PRACTIONER) |
| Mailing Address: | 214 S Burnside Ave Ste A Gonzales |
| State: | LA US |
| Postal Code: | 707373463 |
| Phone Number: | 2256476636 |
| Fax Number: | 2256473849 |
| NPI Enumeration Date: | 05/29/2008 |
| NPI Last Update Date: | 05/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD09828R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |