Organization
EVANGELINE SURGICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG ROBERT THOMPSON M.D. (MANAGER MEMBER)
(337) 363-2050
Entity
Organization
Contact information
Practice address
504 JACK MILLER RD STE 6, VILLE PLATTE, LA 70586-5600
(337) 363-2050
Mailing address
504 JACK MILLER RD STE 6, VILLE PLATTE, LA 70586-5600
(337) 363-2050
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22520
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1486108
—
LA
Enumeration date
01/17/2007
Last updated
08/22/2020
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