# COMMUNITY MEDICAL GROUP- ST BERNARD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205264868
- **Authorized official:** MR. JOHN W MCDANIEL (MANAGING DIRECTOR)
- **Authorized official phone:** (504) 522-2014

## Contact information

- **Practice address:** 8050 W JUDGE PEREZ DR, SUITE 2300, CHALMETTE, LA 70043-1734
- **Practice address phone:** (504) 826-9655
- **Practice address fax:** (504) 826-9656
- **Mailing address:** PO BOX 789, OCEAN SPRINGS, MS 39566-0789
- **Mailing address phone:** (228) 818-0563
- **Mailing address fax:** (228) 818-0519

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | — |

## Other

- **Enumeration date:** 10/17/2013
- **Last updated:** 09/02/2015