Slidell Internal Medicine Clinic LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

11339R Issued in LA

Legal business name

SLIDELL INTERNAL MEDICINE CLINIC LLC

Practice address

105 Medical Center Dr
Suite 301
Slidell, LA 70461-5544

Phone

(985) 646-0123

Fax

(985) 641-0330

NPI assigned

May 9, 2007

Last updated

Dec 28, 2007By 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

Dr. Allan Quibilan Larcena, MDNPI 1275579724

Title

Owner

Phone

(985) 646-0123

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 2

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.

• Allan Quibilan Larcena, MD

  • Internal Medicine Physician
  • Slidell, LA
  • NPI 1275579724
  Medicare reassignment NPD Authorized official
• Aleta Natasha Declouet, M.D.

  • Internal Medicine Physician
  • Slidell, LA
  • NPI 1033163977
  NPD (past)

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1700090016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MEDICAL CENTER DR",
            "address_2": "SUITE 301",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615544",
            "telephone_number": "985-646-0123",
            "fax_number": "985-641-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MEDICAL CENTER DR",
            "address_2": "SUITE 301",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615544",
            "telephone_number": "985-646-0123",
            "fax_number": "985-641-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLIDELL INTERNAL MEDICINE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "LARCENA",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "QUIBILAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-646-0123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "11339R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1662097",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; 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.