1245429273 NPI number — SPRINGER FAMILY MEDICAL CLINIC LLC

Table of content: (NPI 1245429273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245429273 NPI number — SPRINGER FAMILY MEDICAL CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGER FAMILY MEDICAL CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245429273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 DR. MICHEAL DEBAKEY DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70601-5815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-436-1370
Provider Business Mailing Address Fax Number:
337-436-1621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 DR. MICHEAL DEBAKEY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-5815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-436-1370
Provider Business Practice Location Address Fax Number:
337-436-1621
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPRINGER
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
337-436-1370

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  023883 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1487414 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5CF97 . This is a "MEDICARE GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 436596843B . This is a "BLUE CROSS IND." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 5A676 . This is a "MEDICARE IND" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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