1336288752 NPI number — L THOMAS CASHIO MD & MARK JUNEAU JR MD,PC

Table of content: MR. WILLIAM KEITH MODENBACH DC (NPI 1720149487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336288752 NPI number — L THOMAS CASHIO MD & MARK JUNEAU JR MD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L THOMAS CASHIO MD & MARK JUNEAU JR MD,PC
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:
1336288752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/26/2023
NPI Reactivation Date:
10/24/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 AVENUE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARRERO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70072-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-349-6804
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 AVENUE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARRERO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70072-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-349-6804
Provider Business Practice Location Address Fax Number:
504-349-6844
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WAX
Authorized Official First Name:
BARTON
Authorized Official Middle Name:
LLOYD
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
504-579-6945

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1792217 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK4990 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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