1710281431 NPI number — SHAHID MANSOOR, M.D. A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1710281431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710281431 NPI number — SHAHID MANSOOR, M.D. A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAHID MANSOOR, M.D. A PROFESSIONAL MEDICAL CORPORATION
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:
AVOYELLES PEDIATRICS
Provider Other Organization Name Type Code:
3
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:
1710281431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
338 MOREAU ST STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARKSVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71351-2957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-253-7022
Provider Business Mailing Address Fax Number:
318-253-7944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 MEDICAL CENTER DR STE 3A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-8124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-484-3899
Provider Business Practice Location Address Fax Number:
318-484-3887
Provider Enumeration Date:
01/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RACHAL
Authorized Official First Name:
KRISTA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-484-3899

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  13654R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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