1518944826 NPI number — DR. DARBY CHARLES CHIASSON OD

Table of content: DORTHIE OWENS (NPI 1538814355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518944826 NPI number — DR. DARBY CHARLES CHIASSON OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIASSON
Provider First Name:
DARBY
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1518944826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16140 WEST MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUT OFF
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-632-2884
Provider Business Mailing Address Fax Number:
985-632-6640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16140 WEST MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUT OFF
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-632-2884
Provider Business Practice Location Address Fax Number:
985-632-6640
Provider Enumeration Date:
12/28/2005

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: 152W00000X , with the licence number:  LA1271430T , 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: 050583003 . This is a "GREATWEST HEALTHCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "THE PYRAMID GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1566471 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: H0056 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "HUMANA MILITARY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "GILSBAR" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "PYRAMID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "HUMANA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "ADVANTRA FREEDOM" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "AMERICAN LIFECARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "CIGNA GOVERNMENT SERVICES" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "BENEFIT MANAGEMENT" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "CONSOLIDATED HEALTHCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "PPOPLUS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "APW HEALTH PLAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 050583003 . This is a "OFFICE OF GROUP BENEFITS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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