1043329071 NPI number — DR. TINTIN DEVOE A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1043329071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043329071 NPI number — DR. TINTIN DEVOE A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. TINTIN DEVOE 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:
MANDEVILLE PEDIATRIC CLINIC
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:
1043329071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4880 HIGHWAY 22
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70471-6748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-845-8894
Provider Business Mailing Address Fax Number:
985-845-1969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4880 HIGHWAY 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70471-6748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-845-8894
Provider Business Practice Location Address Fax Number:
985-845-1969
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEVOE
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
985-845-8894

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  016922 , 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: 0678432 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 174540401769 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4254173 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53252 . This is a "BLUE CROSS / BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26652840A . This is a "BLUE CROSS FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1447048 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1200111 . This is a "UNITEDHEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1326551 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85720 . This is a "COVENTRY HEALTH" identifier . This identifiers is of the category "OTHER".




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