NPIMap

Organization Active NPI

Southeast Neuroscience Center, LLC

  • Neurology Physician
  • Thibodaux, LA
National Provider Identifier
1962881573
Registry record updated Nov 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
SOUTHEAST NEUROSCIENCE CENTER, LLC
Practice address
970 S Acadia Rd
Thibodaux, LA 70301-4978
Phone
(985) 917-3007
Fax
(985) 447-4209
NPI assigned
May 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2015

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

Authorized official

Name
Mr. Gabriel Lee Nugent
Title
Director
Phone
(985) 850-6805

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X

Addresses

Primary practice location

970 S Acadia Rd
Thibodaux, LA 70301-4978

Mailing address

PO Box 4051
Houma, LA 70361-4051
Phone (985) 917-3007

Other identifiers 1

IdentifierTypeStateIssuer
1947482MedicaidLA

Other names 1

  • Southeast Neuroscience Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southeast Neuroscience Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446681600000",
    "number": "1962881573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4051",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703614051",
            "telephone_number": "985-917-3007",
            "fax_number": "985-917-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 S ACADIA RD",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014978",
            "telephone_number": "985-917-3007",
            "fax_number": "985-447-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST NEUROSCIENCE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-28",
        "last_updated": "2015-11-05",
        "status": "A",
        "authorized_official_last_name": "NUGENT",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "985-850-6805",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1947482",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Neuroscience Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thibodaux, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; 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.