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SOUTHCARE MEDICAL LLC NPI 1093170433


NPI Information

NPI: 1093170433
Provider Name: SOUTHCARE MEDICAL LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
110 CURRAN LN
LAFAYETTE, LA
ZIP 70506
Phone: (337) 706-7700
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SOUTHCARE MEDICAL LLC is a primary care clinic center in Lafayette, LA. SOUTHCARE MEDICAL LLC NPI is 1093170433. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

110 CURRAN LN
LAFAYETTE, LA
ZIP 70506
Phone: (337) 706-7700
Fax: (337) 706-7710

The provider's authorized official is Budi Sugeng .
The authorized official title is Md and has the following contact phone number (337) 422-6240.

The enumeration date for this NPI number is 12/30/2015 and was last updated on 10/5/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsMD200292LOUISIANANo
2363LF0000XNurse PractitionerFamilyAP07807LOUISIANANo
3261QP2300XClinic/CenterPrimary CareYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
119D2091426OTHERLOUISIANACLIA WAIVER
22409930MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.