Southern Medical Holding Corporation

Primary specialty

Sonography Specialist/Technologist CardiovascularTaxonomy code 246XS1301X

License

170011032 Issued in LA

Legal business name

SOUTHERN MEDICAL HOLDING CORPORATION

Doing business as

Southern Medical Corporation

Practice address

12133 Industriplex Blvd
Baton Rouge, LA 70809-5129

Phone

(225) 756-5239

Fax

(225) 752-2614

NPI assigned

Jan 12, 2006

Last updated

Jun 28, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David P Melancon, CPA, MBA

Title

Coo/Cfo

Phone

(225) 756-5239

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Southern Medical Corporation Doing business as

Medicare fee-for-service enrollment

Enrolled in LA, MS2 enrollments

Enrollment records 2

Practitioners 4

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.

• Harold George Clausen, MD

  • Interventional Cardiology Physician
  • Baton Rouge, LA
  • NPI 1417958240
  NPD
• Daniel Thomas Fontenot, MD

  • Interventional Cardiology Physician
  • Baton Rouge, LA
  • NPI 1356342513
  NPD
• William Kenneth Mask, M.D.

  • Diagnostic Radiology Physician
  • Durham, NC
  • NPI 1215030507
  NPD
• Donnie Batie, MD

  • Family Medicine Physician
  • Baton Rouge, LA
  • NPI 1083724736
  NPD (past)

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1558340083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12133 INDUSTRIPLEX BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708095129",
            "telephone_number": "225-756-5239",
            "fax_number": "225-752-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12133 INDUSTRIPLEX BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708095129",
            "telephone_number": "225-756-5239",
            "fax_number": "225-752-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MEDICAL HOLDING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-12",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "MELANCON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "COO/CFO",
        "authorized_official_telephone_number": "225-756-5239",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA, MBA"
    },
    "taxonomies": [
        {
            "code": "246XS1301X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist Cardiovascular, Sonography",
            "state": "LA",
            "license": "170011032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1121894",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506047901",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROV.NUMBER",
            "identifier": "C3563",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Medical Corporation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southern Care Providers, Inc
• Southern Care Providers, Inc
• Southern Care Providers, Inc
• Southern Care Providers, Inc.
• Southern Life Care LLC
• Southern Neuromonitoring, LLC
• Southern Nursing Home Health
• Southern Nursing Home Health (Gonzales Home Health)
• Southern Regional Medical Center
• Southern Regional Wound Care Consultants, LLC

• Sonography Specialist/Technologist Cardiovascular in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Sonography Specialist/Technologist Cardiovascular in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.