Organization
NORTHSHORE FAMILY MED. CTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM CASEY (BUSINESS ADMINISTRATOR)
(985) 646-1122
Entity
Organization
Contact information
Practice address
1150 ROBERT BLVD, #100, SLIDELL, LA 70458
(985) 646-1122
(985) 646-1315
Mailing address
1150 ROBERT BLVD, #100, SLIDELL, LA 70458
(985) 646-1122
(985) 646-1315
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
LA
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1798622
—
LA
01
—
36092
BLUE CROSS
LA
01
—
CT0105
RAILROAD MEDICARE
LA
Enumeration date
05/26/2006
Last updated
02/03/2010
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