1St a Southeast Incs, LLC
Organization Active NPI Point of Service · Houma, LA
NPI 1295952190 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1295952190
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Point of Service 305S00000X
- License
- 12649 (LA)
- Legal business name
- 1ST A SOUTHEAST INCS, LLC
- Practice address
- 614 Roussell St
Houma, LA 70360-4556 - Phone
- (985) 876-0559
- NPI assigned
- Apr 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Suzanne Dickerson
- Title
- Program Coordinator
- Phone
- (985) 876-0559
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- 1St a Southeast Incs LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Point of Service | 305S00000X | 12649 | LA | Yes |
Addresses
Primary practice location
614 Roussell St
Houma, LA 70360-4556
Mailing address
614 Roussell St
Houma, LA 70360-4556
Phone (985) 876-0559
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1170801 | Medicaid | LA |
Other providers in Houma, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.