Organization
NORTHLAKE SURGICAL ASSOCIATES, LTD A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SABRINA W HEBERT (OFFICE MANAGER)
(985) 892-3766
Entity
Organization
Contact information
Practice address
606 W 11TH AVE, COVINGTON, LA 70433-3630
(985) 892-3766
(985) 893-9567
Mailing address
PO BOX 128, COVINGTON, LA 70434-0128
(985) 892-3766
(985) 893-9567
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1791873
—
LA
Enumeration date
03/02/2007
Last updated
10/28/2010
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