1497032544 NPI number — LEAH MCMORRIS PA

Table of content: LEAH MCMORRIS PA (NPI 1497032544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497032544 NPI number — LEAH MCMORRIS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMORRIS
Provider First Name:
LEAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1497032544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5408 FLANDERS DR
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:
70808-9168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-769-5554
Provider Business Mailing Address Fax Number:
225-761-3334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4845 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B1
Provider Business Practice Location Address City Name:
ZACHARY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70791-3943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-761-5597
Provider Business Practice Location Address Fax Number:
225-761-5270
Provider Enumeration Date:
11/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA200468 , 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: 00958218 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2336223 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 984896169 . This is a "TID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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