Provider Demographics
NPI:1548650831
Name:GIAMBELLUCA MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:GIAMBELLUCA MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIAMBELLUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-393-0610
Mailing Address - Street 1:8732 HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2228
Mailing Address - Country:US
Mailing Address - Phone:504-393-0610
Mailing Address - Fax:504-393-0710
Practice Address - Street 1:8732 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037
Practice Address - Country:US
Practice Address - Phone:504-393-0610
Practice Address - Fax:504-393-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1319627Medicaid