1447324132 NPI number — ENDOCENTER, LLC

Table of content: (NPI 1447324132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447324132 NPI number — ENDOCENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOCENTER, 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:
1447324132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848816
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-8816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-809-8068
Provider Business Mailing Address Fax Number:
985-893-6908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131-A CHEROKEE ROSE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-7195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-809-8068
Provider Business Practice Location Address Fax Number:
985-809-7172
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRAUEN
Authorized Official First Name:
HAZEL
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
985-871-1721

Provider Taxonomy Codes

  • Taxonomy code: 261QE0800X , with the licence number:  88 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QE0800X , with the licence number: 120 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1568490 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490004975 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".