Provider Demographics
NPI:1437320231
Name:GULF SOUTH MEDICAL & SURGICAL INSTITUTE, INC.
Entity type:Organization
Organization Name:GULF SOUTH MEDICAL & SURGICAL INSTITUTE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:504-471-3100
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70063-0459
Mailing Address - Country:US
Mailing Address - Phone:504-471-3100
Mailing Address - Fax:504-471-3109
Practice Address - Street 1:600 N HIGHWAY 190 STE 201
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5083
Practice Address - Country:US
Practice Address - Phone:985-892-5497
Practice Address - Fax:985-892-9088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULF SOUTH MEDICAL & SURGICAL INSTITUTE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207NI0002X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1114723Medicaid
LA5CQ92Medicare PIN