NPIMap

Organization Active NPI

M a Culasso, LLC

  • Family Medicine Physician
  • Slidell, LA
National Provider Identifier
1083617237
Registry record updated Apr 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
013032 Issued in LA
Legal business name
M A CULASSO, LLC
Practice address
1520 Gause Blvd
Slidell, LA 70458-2208
Phone
(985) 649-0945
Fax
(985) 643-8510
NPI assigned
May 23, 2005
Last updated
Apr 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Miguel A Culasso, MD
Title
Owner/Physician
Phone
(985) 646-0945

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 013032 LA Primary

Addresses

Primary practice location

1520 Gause Blvd
Slidell, LA 70458-2208

Mailing address

PO Box 729
Slidell, LA 70459-0729
Phone (985) 646-0945

Other identifiers 1

IdentifierTypeStateIssuer
1444278MedicaidLA

National Provider Directory

National Provider Directory

Locations

659 Old Spanish Trl
Slidell, LA 70458
Phone (504) 847-0024

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301961600000",
    "number": "1083617237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 729",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704590729",
            "telephone_number": "985-646-0945",
            "fax_number": "985-643-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 GAUSE BLVD",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582208",
            "telephone_number": "985-649-0945",
            "fax_number": "985-643-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M A CULASSO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2011-04-05",
        "status": "A",
        "authorized_official_last_name": "CULASSO",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "985-646-0945",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "013032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1444278",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.