1265715221 NPI number — NATIONAL MEDICAL SUPPLIERS LLC

Table of content: ANDRE M KALLAB M.D. (NPI 1669475760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265715221 NPI number — NATIONAL MEDICAL SUPPLIERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL MEDICAL SUPPLIERS 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:
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:
1265715221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 870653
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70187-0653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-905-9799
Provider Business Mailing Address Fax Number:
188-875-1794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2045 N 3RD ST APT 314
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70802-5182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-906-3869
Provider Business Practice Location Address Fax Number:
888-751-7947
Provider Enumeration Date:
09/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LYMON
Authorized Official First Name:
KAISHA
Authorized Official Middle Name:
MONIQUE
Authorized Official Title or Position:
MEMBER MANAGER
Authorized Official Telephone Number:
504-905-9799

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  000.602 , 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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