SOUTHERN UROLOGY LLC NPI 1104534965

NPI Information

  • NPI: 1104534965
  • Provider Name: SOUTHERN UROLOGY LLC
  • Classification: Urology - 208800000X
  • Entity Type: Organization
  • CLIA Number: 19D2299632
  • Address: 2308 E MAIN ST STE A
    NEW IBERIA, LA
    ZIP 70560
  • Phone: (337) 408-8676

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NPI Details

SOUTHERN UROLOGY LLC is an urology in New Iberia, LA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. SOUTHERN UROLOGY LLC NPI is 1104534965. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2308 E MAIN ST STE A
NEW IBERIA, LA
ZIP 70560-029
Phone: (337) 408-8676

The provider's authorized official is Mark Robert Eldredge .
The authorized official title is Ao and has the following contact phone number (337) 769-7779.

The CLIA number assigned to this NPI record is 19D2299632 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/10/2022 and was last updated on 4/2/2024.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrologyYes

What is NPI?

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This page was last updated on: 3/30/2025

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