1306961065 NPI number — STERLINGTON HEALTHCARE, LLP

Table of content: PORUS SHRENIK SHAH M.D (NPI 1447652953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306961065 NPI number — STERLINGTON HEALTHCARE, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STERLINGTON HEALTHCARE, LLP
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:
1306961065
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:
115 HIGHWAY 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71280-3009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-665-4543
Provider Business Mailing Address Fax Number:
318-665-4539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 HIGHWAY 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71280-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-665-4543
Provider Business Practice Location Address Fax Number:
318-665-4539
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOYTE
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
318-665-4543

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  073 , 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: 1442151 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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