1487896122 NPI number — WETSMAN FORENSIC MEDICINE LLC

Table of content: (NPI 1487896122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487896122 NPI number — WETSMAN FORENSIC MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WETSMAN FORENSIC MEDICINE 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:
TOWNSEND
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:
1487896122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4540 AMBASSADOR CAFFERY PKWY
Provider Second Line Business Mailing Address:
SUITE C-110
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-6928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-326-4619
Provider Business Mailing Address Fax Number:
504-894-8744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 PRYTANIA ST
Provider Second Line Business Practice Location Address:
SUITE 72
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70115-3628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-894-8322
Provider Business Practice Location Address Fax Number:
504-894-8744
Provider Enumeration Date:
03/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WETSMAN
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
504-430-0578

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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