1396156790 NPI number — NEW ORLEANS CENTER FOR AESTHETICS AND PLASTIC SURGERY,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 1396156790 NPI number — NEW ORLEANS CENTER FOR AESTHETICS AND PLASTIC SURGERY,LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ORLEANS CENTER FOR AESTHETICS AND PLASTIC SURGERY,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:
1396156790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2633 NAPOLEON AVE
Provider Second Line Business Mailing Address:
SUITE 920
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70115-6357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-533-8848
Provider Business Mailing Address Fax Number:
504-533-8848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2633 NAPOLEON AVE
Provider Second Line Business Practice Location Address:
SUITE 920
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70115-6357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-533-8848
Provider Business Practice Location Address Fax Number:
504-533-8848
Provider Enumeration Date:
05/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRICK
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
GERARD
Authorized Official Title or Position:
FOUNDER/OWNER
Authorized Official Telephone Number:
504-914-8230

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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