1043205446 NPI number — PRIMARY OCCUPATIONAL HEALTH SERVICES, L.L.C.

Table of content: MRS. ELIZABETH HUNTER JORDAN RPH (NPI 1588642334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043205446 NPI number — PRIMARY OCCUPATIONAL HEALTH SERVICES, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY OCCUPATIONAL HEALTH SERVICES, L.L.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:
LAFOURCHE SERVICES, LLC
Provider Other Organization Name Type Code:
4
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:
1043205446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2510 N ALEX PLAISANCE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN MEADOW
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70357-2351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-475-6555
Provider Business Mailing Address Fax Number:
985-475-8643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 N ALEX PLAISANCE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN MEADOW
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70357-2351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-475-6555
Provider Business Practice Location Address Fax Number:
985-475-8643
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
JOEY
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
DEVELOPMENT MANAGER
Authorized Official Telephone Number:
985-475-6555

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , 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)





Copyright © 2007-2024 www.npivalidator.com