Organization
ASSURED MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS L EWING (PROGRAM DIRECTOR)
(337) 654-5871
Entity
Organization
Contact information
Practice address
200 AMERICAN LEGION DR, RAYNE, LA 70578-5826
(337) 654-5871
(225) 208-1415
Mailing address
139 JAMES COMEAUX RD STE B, NO 575, LAFAYETTE, LA 70508-3376
(337) 654-5871
(122) 520-8141
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
PCA 15206
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03 CHILDREN CHOICE
—
LA
05
—
06 NOW PROFESSIONAL
—
LA
05
—
24 PERSONAL CARE SER
—
LA
05
—
70 EPSDT
—
LA
05
—
73 SOCIAL WORKER
—
LA
05
—
82 PCA WAIVER
—
LA
05
—
89 SIL WAIVER
—
LA
Enumeration date
04/07/2009
Last updated
04/07/2009
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