James Raymond

  
 Gulf Coast 
 SURGICAL CENTER, LLC 
 402 Dunn Street 
 Houma, LA 74860 (985) 848-1481 Fax (948) 848-6488 
 Tax ID: 20-3387608
 NPI #: 124254251 
 B/C#: 1678940337694Z 
 Insurance Verification Form 
 Pt. Name: James Raymond 
 birthdate: 1997 July 15 
 MR# 48448-3 
 BCBS OF LA HMO 
 Insurance Company: 
 Phone Number: 1-727-236-5342
 Insured Name: SELF 
 Relationship to Patient: 
 Policy Number: IHQ867894033769 
 Group Number: 
 Effective Date: 2022 September 24
 Policy paid thru: ACTIVE 
 procedure date: 2022 November 13
 Pre-cert company name: 
 Claims Address: BCBS OF LA 
 Does policy follow MNRP/MRC2? yes or no 
 PO BOX 94829 
 Do benefits co-incide? 
 yes or no 
 BATON ROUGE, LA 70488 
 Rep. Name: ONLINE 1 Austin 
