1609837020 NPI number — MICHELLE R RITTER M.D.

Table of content: MICHELLE R RITTER M.D. (NPI 1609837020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609837020 NPI number — MICHELLE R RITTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RITTER
Provider First Name:
MICHELLE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1609837020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6640
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71136-6640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-686-9986
Provider Business Mailing Address Fax Number:
318-686-9505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
385 BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71106-8158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-686-9986
Provider Business Practice Location Address Fax Number:
318-686-9505
Provider Enumeration Date:
03/28/2006

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: 207XS0106X , with the licence number:  10060R , 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: 1900H3213Z . This is a "BCBS OF LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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