# ST JUDE MEDICAL GROUP LLC

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

## Provider details

- **NPI number:** 1396086211
- **Authorized official:** DR. JUDE AGENDIA M.D. (OWNER)
- **Authorized official phone:** (337) 564-6722

## Contact information

- **Practice address:** 4150 NELSON RD, BLDG E SUITE 4, LAKE CHARLES, LA 70605-4148
- **Practice address phone:** (337) 564-6722
- **Mailing address:** 4150 NELSON RD, BLDG E SUITE 4, LAKE CHARLES, LA 70605-4148

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/04/2013
- **Last updated:** 03/04/2013