1013342583 NPI number — PARTNERS HEALTHCARE GROUP OF LOUISIANA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013342583 NPI number — PARTNERS HEALTHCARE GROUP OF LOUISIANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS HEALTHCARE GROUP OF LOUISIANA, LLC
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:
6
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:
1013342583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3525 PIEDMONT RD NE
Provider Second Line Business Mailing Address:
SUITE 8-515
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305-1578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-692-4417
Provider Business Mailing Address Fax Number:
404-287-2880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 LA RUE FRANCE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508-3144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-264-1650
Provider Business Practice Location Address Fax Number:
337-264-1649
Provider Enumeration Date:
09/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RADICS
Authorized Official First Name:
ROB
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
404-692-4417

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  2203781754 , 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)





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