1366620494 NPI number — DELTA AMERICAN HEALTHCARE, INC

Table of content: (NPI 1366620494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366620494 NPI number — DELTA AMERICAN HEALTHCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA AMERICAN HEALTHCARE, INC
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:
1366620494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELHI
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71232-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-878-9058
Provider Business Mailing Address Fax Number:
318-878-9053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELHI
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71232-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-878-9058
Provider Business Practice Location Address Fax Number:
318-878-9053
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PRISOCK
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
318-878-9058

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: 3913 , 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: 1717312 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1713457 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718513 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1170780 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1717690 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718416 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718564 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1713171 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1913120 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1540978 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1671851 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718394 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718556 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1435520 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1713414 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718408 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718530 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1979104 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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