1396800553 NPI number — EDWARD J BOOS DDS & ANTHONY INDOVINA DDS A PC

Table of content: MICHAEL JAMES MOLAMPHY O.D.. (NPI 1609903848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396800553 NPI number — EDWARD J BOOS DDS & ANTHONY INDOVINA DDS A PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD J BOOS DDS & ANTHONY INDOVINA DDS A 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:
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:
1396800553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4224 HOUMA BLVD
Provider Second Line Business Mailing Address:
SUITE 670
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-2933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-446-5033
Provider Business Mailing Address Fax Number:
504-456-5057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4224 HOUMA BLVD
Provider Second Line Business Practice Location Address:
SUITE 670
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-2933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-446-5033
Provider Business Practice Location Address Fax Number:
504-456-5057
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOOS
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
504-456-5033

Provider Taxonomy Codes

  • Taxonomy code: 1223P0106X , with the licence number:  2577 , 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: A2654 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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