| NPI | 1073497871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA KENNERSON Director Of Strategic Development 337-356-7044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-09-08 |