1518073576 NPI number — ERIC R EHLENBERGER

Table of content: ERIC R EHLENBERGER (NPI 1518073576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518073576 NPI number — ERIC R EHLENBERGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EHLENBERGER
Provider First Name:
ERIC
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1518073576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 VETERANS MEMORIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 16
Provider Business Mailing Address City Name:
KENNER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70062-4730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-472-6130
Provider Business Mailing Address Fax Number:
504-472-6128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 VETERANS MEMORIAL BLVD STE 16
Provider Second Line Business Practice Location Address:
ACCURATE CLINIC
Provider Business Practice Location Address City Name:
KENNER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70062-4779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-472-6130
Provider Business Practice Location Address Fax Number:
504-472-6128
Provider Enumeration Date:
08/22/2006

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: 207P00000X , with the licence number:  014927 , 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)