1528239555 NPI number — RICHARD J. BIDSTRUP, M.D. LTD.

Table of content: (NPI 1528239555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528239555 NPI number — RICHARD J. BIDSTRUP, M.D. LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD J. BIDSTRUP, M.D. LTD.
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:
EAR, NOSE, THROAT, AND ALLERGY CLINIC
Provider Other Organization Name Type Code:
5
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:
1528239555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4049 I 49 S SERVICE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPELOUSAS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70570-0757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-942-2674
Provider Business Mailing Address Fax Number:
337-948-1858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4049 I 49 S SERVICE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELOUSAS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70570-0757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-942-2674
Provider Business Practice Location Address Fax Number:
337-948-1858
Provider Enumeration Date:
03/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BIDSTRUP
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
337-942-2674

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  L009234 , 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: 4354896360 . This is a "BLUE CROSS BLUE SHIELD LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1153834 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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