# SLIDELL INTERNAL MEDICINE CLINIC LLC

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

## Provider details

- **NPI number:** 1700090016
- **Authorized official:** DR. ALLAN QUIBILAN LARCENA MD (OWNER)
- **Authorized official phone:** (985) 646-0123

## Contact information

- **Practice address:** 105 MEDICAL CENTER DR, SUITE 301, SLIDELL, LA 70461-5544
- **Practice address phone:** (985) 646-0123
- **Practice address fax:** (985) 641-0330
- **Mailing address:** 105 MEDICAL CENTER DR, SUITE 301, SLIDELL, LA 70461-5544
- **Mailing address phone:** (985) 646-0123
- **Mailing address fax:** (985) 641-0330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 11339R | LA | Yes |

## Other

- **Enumeration date:** 05/09/2007
- **Last updated:** 12/28/2007