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Organization

SOUTHERN MEDICAL HOLDING CORPORATION

Active
Other names
Southern Medical Corporation
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID P MELANCON CPA, MBA (COO/CFO)
(225) 756-5239
Entity
Organization

Contact information

Practice address
12133 INDUSTRIPLEX BLVD, BATON ROUGE, LA 70809-5129
(225) 756-5239
(225) 752-2614
Mailing address
12133 INDUSTRIPLEX BLVD, BATON ROUGE, LA 70809-5129
(225) 756-5239
(225) 752-2614

Taxonomy

Speciality
Code
Description
License number
State
246XS1301X
Sonography Specialist/Technologist Cardiovascular
Primary
170011032
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1121894
LA
05
506047901
MO
01
C3563
BLUE CROSS PROV.NUMBER
LA
Enumeration date
01/12/2006
Last updated
06/28/2013
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