1073576823 NPI number — POINTE COUPEE BETTER ACCESS COMMUNITY HEALTHCARE

Table of content: (NPI 1073576823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073576823 NPI number — POINTE COUPEE BETTER ACCESS COMMUNITY HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POINTE COUPEE BETTER ACCESS COMMUNITY HEALTHCARE
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:
1073576823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 979
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ROADS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-638-8900
Provider Business Mailing Address Fax Number:
225-638-8833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 ROBERTS DRIVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
NEW ROADS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-638-8900
Provider Business Practice Location Address Fax Number:
225-638-8833
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVID
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
225-638-8900

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1447854 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com