1689612988 NPI number — RICHARDSON MEDICAL CENTER HOMECARE

Table of content: (NPI 1689612988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689612988 NPI number — RICHARDSON MEDICAL CENTER HOMECARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARDSON MEDICAL CENTER HOMECARE
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:
1689612988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 51266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70505-1266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-233-1307
Provider Business Mailing Address Fax Number:
337-233-5764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1612 JULIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71269-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-728-5397
Provider Business Practice Location Address Fax Number:
318-728-4067
Provider Enumeration Date:
06/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NOVEMBER
Authorized Official First Name:
PETER
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
337-233-1307

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1027 , 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: 190030890Z . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1402532 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".