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SLIDELL INTERNAL MEDICINE CLINIC LLC NPI 1700090016


NPI Information

NPI: 1700090016
Provider Name: SLIDELL INTERNAL MEDICINE CLINIC LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 19D1055100

Address:
105 MEDICAL CENTER DR
SUITE 301
SLIDELL, LA
ZIP 70461
Phone: (985) 646-0123
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SLIDELL INTERNAL MEDICINE CLINIC LLC is an internal medicine in Slidell, LA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. SLIDELL INTERNAL MEDICINE CLINIC LLC NPI is 1700090016. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

105 MEDICAL CENTER DR
SUITE 301
SLIDELL, LA
ZIP 70461-544
Phone: (985) 646-0123
Fax: (985) 641-0330

The provider's authorized official is Allan Quibilan Larcena .
The authorized official title is Owner and has the following contact phone number (985) 646-0123.

The CLIA number assigned to this NPI record is 19D1055100 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/9/2007 and was last updated on 12/28/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal Medicine11339RLOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
15W341MEDICARE ID-TYPE UNSPECIFIEDLOUISIANA
21662097MEDICAIDLOUISIANA
3G09158MEDICARE UPINLOUISIANA
45CU10MEDICARE ID-TYPE UNSPECIFIEDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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