Organization
COMMUNITY MEDICAL GROUP- ST BERNARD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN W MCDANIEL (MANAGING DIRECTOR)
(504) 522-2014
Entity
Organization
Contact information
Practice address
8050 W JUDGE PEREZ DR, SUITE 2300, CHALMETTE, LA 70043-1734
(504) 826-9655
(504) 826-9656
Mailing address
PO BOX 789, OCEAN SPRINGS, MS 39566-0789
(228) 818-0563
(228) 818-0519
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
331631
MEDICARE PTAN
LA
Enumeration date
10/17/2013
Last updated
09/02/2015
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