NPIMap

Organization Active NPI

Southern Urology LLC

  • Urology Physician
  • Lafayette, LA
National Provider Identifier
1760612865
Registry record updated Jan 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
SOUTHERN UROLOGY LLC
Practice address
1016 Coolidge Blvd
Lafayette, LA 70503-2436
Phone
(337) 233-6665
Fax
(337) 233-0327
NPI assigned
Jul 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2010

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

Authorized official

Name
Edward F Breaux, M.D.
Title
Managing Member
Phone
(337) 233-6665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

1016 Coolidge Blvd
Lafayette, LA 70503-2436

Mailing address

PO Box 54028
Lafayette, LA 70505-4028
Phone (337) 233-6665

Other identifiers 2

IdentifierTypeStateIssuer
1305308MedicaidLA
5DF66OtherLAMEDICARE

Other names 1

  • Coolidge Location Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262563200000",
    "number": "1760612865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54028",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705054028",
            "telephone_number": "337-233-6665",
            "fax_number": "337-233-0327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 COOLIDGE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032436",
            "telephone_number": "337-233-6665",
            "fax_number": "337-233-0327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN UROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-23",
        "last_updated": "2010-01-04",
        "status": "A",
        "authorized_official_last_name": "BREAUX",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "337-233-6665",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1305308",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "5DF66",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coolidge Location",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; 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.