NPIMap

Organization Active NPI

Perfusion Vascular Vidalia LLC

  • Vascular Surgery Physician
  • Vidalia, LA
National Provider Identifier
1356875637
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
PERFUSION VASCULAR VIDALIA LLC
Practice address
107 Front St
Vidalia, LA 71373-2836
Phone
(985) 892-7070
Fax
(985) 892-7017
NPI assigned
Apr 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Authorized official

Name
Shaun R Carpenter, M.D.
Title
Owner
Phone
(985) 892-7070

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

107 Front St
Vidalia, LA 71373-2836

Mailing address

PO Box 1089
Hammond, LA 70404
Phone (985) 892-7070

National Provider Directory

National Provider Directory

Locations

211 4th St
Ste 1B
Alexandria, LA 71301
Phone (318) 545-0655

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1356875637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1089",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "70404",
            "telephone_number": "985-892-7070",
            "fax_number": "985-892-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713732836",
            "telephone_number": "985-892-7070",
            "fax_number": "985-892-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFUSION VASCULAR VIDALIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-13",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-892-7070",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vidalia, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; 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.