Organization
ST. BERNARD EMERGENCY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(337) 609-1221
Entity
Organization
Contact information
Practice address
8000 W JUDGE PEREZ DR, CHALMETTE, LA 70043-1668
(504) 826-9500
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
(337) 262-7246
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2441418
—
LA
01
—
567451
MEDICARE OF LOUISIANA
LA
Enumeration date
03/06/2017
Last updated
03/23/2022
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