Organization Name: | SOUTHCARE MEDICAL LLC |
NPI Number: | 1215294830 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRISTYANA SUGENG (OFFICE MANAGER) |
Mailing Address: | 1305 N State St Abbeville |
State: | LA US |
Postal Code: | 705102825 |
Phone Number: | 3374226240 |
Fax Number: | 3374226241 |
NPI Enumeration Date: | 04/19/2012 |
NPI Last Update Date: | 05/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 200292 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | LA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |