NPIMap

Organization Active NPI

Neurological Surgery, PMC/LLC

  • Neurological Surgery Physician
  • Slidell, LA
National Provider Identifier
1285650879
Registry record updated Apr 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
015313 Issued in LA
Legal business name
NEUROLOGICAL SURGERY, PMC/LLC
Practice address
1001 Florida Ave
Slidell, LA 70458-2923
Phone
(985) 646-2300
Fax
(985) 646-2306
NPI assigned
Jul 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2013

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

Authorized official

Name
Dr. Louis J Provenza, MD
Title
MD
Phone
(985) 646-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207T00000X 015313 LA Primary

Addresses

Primary practice location

1001 Florida Ave
Slidell, LA 70458-2923

Mailing address

PO Box 550
Slidell, LA 70459-0550

Other identifiers 1

IdentifierTypeStateIssuer
1332402MedicaidLA

Other names 1

  • Neurological Surgery & Spine Center Doing business as

National Provider Directory

National Provider Directory

Locations

1001 Florida Ave
Slidell, LA 70458
Phone (985) 280-7337

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364774400000",
    "number": "1285650879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704590550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 FLORIDA AVE",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582923",
            "telephone_number": "985-646-2300",
            "fax_number": "985-646-2306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROLOGICAL SURGERY, PMC/LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2013-04-01",
        "status": "A",
        "authorized_official_last_name": "PROVENZA",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "985-646-2300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "LA",
            "license": "015313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1332402",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neurological Surgery & Spine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 1, 2013; 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.