Basic Information
| Provider Information | |||||||||
| NPI: | 1093869190 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOVASCULAR SPECILAISTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4224 HOUMA BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044550842 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4224 HOUMA BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044550842 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROLSTON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5044550842 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1348015 | 05 | LA | MEDICAID | 1309869 | 05 | LA | MEDICAID | 1315141 | 05 | LA | MEDICAID | 1398241 | 05 | LA | MEDICAID | 1191205 | 05 | LA | MEDICAID | 1387681 | 05 | LA | MEDICAID |