1609943018 NPI number — STEPHEN G SCULLY M D CAROL W SARTIN M D & SUSAN G SCIONEAUX M D P M C

Table of content: (NPI 1609943018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609943018 NPI number — STEPHEN G SCULLY M D CAROL W SARTIN M D & SUSAN G SCIONEAUX M D P M C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN G SCULLY M D CAROL W SARTIN M D & SUSAN G SCIONEAUX M D P M C
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:
1609943018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 73309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70033-3309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-883-4800
Provider Business Mailing Address Fax Number:
504-883-5554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4648 I 10 SERVICE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-883-4800
Provider Business Practice Location Address Fax Number:
504-883-5554
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCULLY
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
GERALD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
985-230-7263

Provider Taxonomy Codes

  • Taxonomy code: 207ZC0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1940577 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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