1447483110 NPI number — WOMEN'S MEDICAL & SURGICAL CLINIC, INC.

Table of content: (NPI 1447483110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447483110 NPI number — WOMEN'S MEDICAL & SURGICAL CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S MEDICAL & SURGICAL CLINIC, 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:
1447483110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 CHERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAMOU
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70554-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-468-2250
Provider Business Mailing Address Fax Number:
337-468-2702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 CHERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAMOU
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70554-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-468-2250
Provider Business Practice Location Address Fax Number:
337-468-2702
Provider Enumeration Date:
08/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KULKARNI
Authorized Official First Name:
UPENDRA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
337-468-2250

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  05120R , 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: 1811866 . This is a "AMERIGROUP CCN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 4507365 . This is a "EMC" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1900461332 . This is a "CLIA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1811866 . This is a "COMMUNITY HEALTH SOLUTIONS CCN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1811866 . This is a "UNITED HEALTHCARE CCN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1811866 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5DL47 . This is a "MEDICARE PTAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: P10000361561 . This is a "LA HEALTHCARE CONNECTIONS CCN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".