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Organization

SOUTHCARE MEDICAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BUDI SUGENG MD (MD)
(337) 422-6240
Entity
Organization

Contact information

Practice address
110 CURRAN LN, LAFAYETTE, LA 70506
(337) 706-7700
(337) 706-7710
Mailing address
110 CURRAN LN, LAFAYETTE, LA 70506

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD200292
LA
261QP2300X
Primary Care Clinic/Center
Primary
363LF0000X
Family Nurse Practitioner
AP07807
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
19D2091426
CLIA WAIVER
LA
05
2409930
LA
Enumeration date
12/30/2015
Last updated
10/05/2022
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