# SOUTHCARE MEDICAL LLC

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

## Provider details

- **NPI number:** 1215294830
- **Authorized official:** CRISTYANA SUGENG B.A (OFFICE MANAGER)
- **Authorized official phone:** (337) 422-6240

## Contact information

- **Practice address:** 1305 N STATE ST, ABBEVILLE, LA 70510-2825
- **Practice address phone:** (337) 422-6240
- **Practice address fax:** (337) 422-6241
- **Mailing address:** 1305 N STATE ST, ABBEVILLE, LA 70510-2825
- **Mailing address phone:** (337) 422-6240
- **Mailing address fax:** (337) 422-6241

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | MD200292 | LA | — |
| 261QR1300X | Rural Health Clinic/Center | 2203782387 | LA | Yes |
| 363LF0000X | Family Nurse Practitioner | AP07807 | LA | — |

## Other

- **Enumeration date:** 04/19/2012
- **Last updated:** 03/07/2023