Renalsouth of Louisiana, LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

145 Issued in LA

Legal business name

RENALSOUTH OF LOUISIANA, LLC

Doing business as

RenalSouth of St. Tammany

Practice address

397 Highway 21
Suite 602
Madisonville, LA 70447-3407

Phone

(985) 792-5334

Fax

(985) 792-5234

NPI assigned

Jul 14, 2005

Last updated

Aug 22, 2020By 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. Tommy Jay Carter

Title

Ceo

Phone

(205) 943-6700

Specialties & licenses 1

Addresses

Other names 1

• RenalSouth of St. Tammany Doing business as

Locations

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942209713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 MILAN CT",
            "address_2": "SUITE 213",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352116912",
            "telephone_number": "205-943-6700",
            "fax_number": "205-943-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 HIGHWAY 21",
            "address_2": "SUITE 602",
            "city": "MADISONVILLE",
            "state": "LA",
            "postal_code": "704473407",
            "telephone_number": "985-792-5334",
            "fax_number": "985-792-5234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENALSOUTH OF LOUISIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-943-6700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "LA",
            "license": "145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RenalSouth of St. Tammany",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Madisonville, LA
• Providers in Madisonville, LA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.