Organization Name: | EVANGELINE SURGICAL CLINIC LLC |
NPI Number: | 1518019892 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRAIG ROBERT THOMPSON (MANAGER MEMBER) |
Mailing Address: | 504 Jack Miller Rd Ste 6 Ville Platte |
State: | LA US |
Postal Code: | 705865600 |
Phone Number: | 3373632050 |
Fax Number: | |
NPI Enumeration Date: | 01/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 22520 |
Healthcare Provider Taxonomy: (Secondary) | Y |
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. |