Provider Demographics
NPI:1861518185
Name:LOUISIANA MEDICINE AND GERATRICS ASSOCIATES
Entity type:Organization
Organization Name:LOUISIANA MEDICINE AND GERATRICS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PREM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-388-0440
Mailing Address - Street 1:1503 STUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5627
Mailing Address - Country:US
Mailing Address - Phone:318-388-0440
Mailing Address - Fax:318-388-0330
Practice Address - Street 1:1503 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5627
Practice Address - Country:US
Practice Address - Phone:318-388-0440
Practice Address - Fax:318-388-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL12718R207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1542555Medicaid
LA5A746Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
LAG74470Medicare UPIN