1457577637 NPI number — MILLENNIUM HEALTH CARE SERVICES

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 1457577637 NPI number — MILLENNIUM HEALTH CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLENNIUM HEALTH CARE SERVICES
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:
MILLENNIUM PCA SERVICES
Provider Other Organization Name Type Code:
3
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:
1457577637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70895-4301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-923-3117
Provider Business Mailing Address Fax Number:
225-923-3117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 JOHNSTON ST
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-264-1288
Provider Business Practice Location Address Fax Number:
337-264-1289
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOODS
Authorized Official First Name:
DWAINE
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
225-923-3117

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X , with the licence number:  PCA 7051 , 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: 1458848 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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