1306350822 NPI number — DAVID CREGER 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 1306350822 NPI number — DAVID CREGER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID CREGER 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:
1306350822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 BAYOU GENTILLY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70065-6628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-453-0380
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
716 VILLAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-464-8895
Provider Business Practice Location Address Fax Number:
985-781-4319
Provider Enumeration Date:
11/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CREGER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
504-453-0380

Provider Taxonomy Codes

  • Taxonomy code: 364SA2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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