| Southeastern Louisiana Sports Medicine | |
|
548 Western Ave Hammond LA 70402-0001 | |
| (972) 367-4845 | |
| (972) 367-3451 |
| Full Name | Southeastern Louisiana Sports Medicine |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 548 Western Ave, Hammond, Louisiana |
| Authorized Official Name and Position | Mouzon Bass (AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Louisiana Sports Medicine Po Box 650850 Dept 1011 Dallas TX 75265-0850 Ph: (800) 555-9073 | Southeastern Louisiana Sports Medicine 548 Western Ave Hammond LA 70402-0001 Ph: (972) 367-4845 |
| NPI Number | 1578950028 |
|---|---|
| Provider Enumeration Date | 04/22/2015 |
| Last Update Date | 04/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578950028 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Secondary |
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