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Organization
SOUTHCARE MEDICAL LLC
Active
Organization
SOUTHCARE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTYANA SUGENG B.A (OFFICE MANAGER)
(337) 422-6240
Entity
Organization
Contact information
Practice address
1305 N STATE ST, ABBEVILLE, LA 70510-2825
(337) 422-6240
(337) 422-6241
Mailing address
1305 N STATE ST, ABBEVILLE, LA 70510-2825
(337) 422-6240
(337) 422-6241
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD200292
LA
261QR1300X
Rural Health Clinic/Center
Primary
2203782387
LA
363LF0000X
Family Nurse Practitioner
AP07807
LA
Other
Enumeration date
04/19/2012
Last updated
03/07/2023
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