Organization
NEUROLOGICAL SURGERY, PMC/LLC
Active
Other names
Neurological Surgery & Spine Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOUIS J PROVENZA MD (MD)
(985) 646-2300
Entity
Organization
Contact information
Practice address
1001 FLORIDA AVE, SLIDELL, LA 70458-2923
(985) 646-2300
(985) 646-2306
Mailing address
PO BOX 550, SLIDELL, LA 70459-0550
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
015313
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1332402
—
LA
Enumeration date
07/15/2006
Last updated
04/01/2013
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