Organization Active NPI

Stephen G Scully M D Carol W Sartin M D & Susan G Scioneaux M D P M C

  • Anatomic Pathology & Clinical Pathology Physician
  • Metairie, LA
National Provider Identifier
1609943018
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
STEPHEN G SCULLY M D CAROL W SARTIN M D & SUSAN G SCIONEAUX M D P M C
Practice address
4648 I 10 Service Road
Metairie, LA 70001
Phone
(504) 883-4800
Fax
(504) 883-5554
NPI assigned
Nov 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Stephen Gerald Scully, MD
Title
President
Phone
(985) 230-7263

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZC0500X
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

4648 I 10 Service Road
Metairie, LA 70001

Mailing address

PO Box 73309
Metairie, LA 70033-3309
Phone (504) 883-4800

Other identifiers 1

IdentifierTypeStateIssuer
1940577MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050303000226 LA Part B Supplier - Clinic/Group Practice 6800849795 Receives reassigned benefits from 3 practitioners
Practice locations: Hammond, LA; Metairie, LA

National Provider Directory

National Provider Directory

Locations

4228 Houma Blvd
Ste 325
Metairie, LA 70006

Practitioners & affiliated clinicians

Practitioners 3

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": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1609943018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73309",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700333309",
            "telephone_number": "504-883-4800",
            "fax_number": "504-883-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4648 I 10 SERVICE ROAD",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "70001",
            "telephone_number": "504-883-4800",
            "fax_number": "504-883-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN G SCULLY M D CAROL W SARTIN M D & SUSAN G SCIONEAUX M D P M C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "SCULLY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "GERALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "985-230-7263",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1940577",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Metairie, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.