Organization
NORTHSHORE PROVIDER GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES I MATHEWS (OWNER)
(337) 315-9686
Entity
Organization
Contact information
Practice address
48529 RED FOX DR, HAMMOND, LA 70401-3715
(337) 315-9686
Mailing address
PO BOX 1063, HAMMOND, LA 70404-1063
(337) 315-9686
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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