SOUTHEAST NEUROSCIENCE CENTER LLC NPI 1962881573

NPI Information

  • NPI: 1962881573
  • Provider Name: SOUTHEAST NEUROSCIENCE CENTER, LLC
  • Classification: Psychiatry & Neurology - 2084N0400X
  • Specialization: Neurology
  • Entity Type: Organization
  • Doing Business As: SOUTHEAST NEUROSCIENCE CENTER
  • Address: 970 S ACADIA RD
    THIBODAUX, LA
    ZIP 70301
  • Phone: (985) 917-3007

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NPI Details

SOUTHEAST NEUROSCIENCE CENTER, LLC is a neurology psychiatry neurology in Thibodaux, LA. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. SOUTHEAST NEUROSCIENCE CENTER, LLC NPI is 1962881573. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Southeast Neuroscience Center.

The provider's business location address is:

970 S ACADIA RD
THIBODAUX, LA
ZIP 70301-978
Phone: (985) 917-3007
Fax: (985) 447-4209

The provider's authorized official is Gabriel Lee Nugent .
The authorized official title is Director and has the following contact phone number (985) 850-6805.

The enumeration date for this NPI number is 5/28/2015 and was last updated on 11/5/2015.

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
12085R0202XRadiologyDiagnostic RadiologyNo
22084N0400XPsychiatry & NeurologyNeurologyYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11947482MEDICAIDLOUISIANA
25F903MEDICARE PINLOUISIANA

What is NPI?

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This page was last updated on: 11/21/2025

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