Organization
INLAND CARDIOVASCULAR CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM L JOHNSON (NURSE)
(318) 330-9330
Entity
Organization
Contact information
Practice address
614 N 2ND ST, MONROE, LA 71201-6236
(318) 330-9330
(318) 330-9517
Mailing address
PO BOX 1711, MONROE, LA 71210-1711
(318) 330-9330
(318) 330-9517
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11738R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136103002
—
AR
05
—
1681903
—
LA
01
—
32980820A1
BLUE CROSS/BLUE SHIELD
—
Enumeration date
07/14/2010
Last updated
07/14/2010
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