Southern Louisiana Medical Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SOUTHERN LOUISIANA MEDICAL GROUP, LLC

Practice address

2104 Gause Blvd W Ste a
Slidell, LA 70460-4130

Phone

(985) 643-4575

Fax

(833) 222-4520

NPI assigned

Aug 12, 2019

Organization subpart

No

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

Authorized official

Name

Mrs. Karen Drake

Title

General Manager

Phone

(504) 229-7451

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1598311029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7462",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704697462",
            "telephone_number": "985-643-4575",
            "fax_number": "833-222-4520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 GAUSE BLVD W STE A",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704604130",
            "telephone_number": "985-643-4575",
            "fax_number": "833-222-4520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN LOUISIANA MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-12",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "504-229-7451",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "27-2182406",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "eClinicalWorks",
            "affiliation": "N",
            "address_1": "2104 Gause Blvd W Ste A",
            "city": "Slidell",
            "state": "LA",
            "country_code": "US",
            "postal_code": "704604130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Medicine Physician in Slidell, LA
• Providers in Slidell, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; 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.