Provider Demographics
NPI:1902966492
Name:QUENTIN D. FALGOUST MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:QUENTIN D. FALGOUST MD A MEDICAL CORPORATION
Other - Org Name:ADVANCED EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FALGOUST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-446-0506
Mailing Address - Street 1:1101 AUDUBON AVE
Mailing Address - Street 2:STE N-5
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4957
Mailing Address - Country:US
Mailing Address - Phone:985-446-0506
Mailing Address - Fax:985-446-7614
Practice Address - Street 1:1101 AUDUBON AVE STE N5
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4957
Practice Address - Country:US
Practice Address - Phone:985-446-0506
Practice Address - Fax:985-446-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1799726Medicaid
LA56793Medicare ID - Type Unspecified
LA1799726Medicaid