1659886935 NPI number — KREWE OF KIDS, LLC

Table of content: MR. CURT LORD PRACTICAL NURSE (NPI 1952597437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659886935 NPI number — KREWE OF KIDS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KREWE OF KIDS, LLC
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:
KREWE OF KIDS PEDIATRICS
Provider Other Organization Name Type Code:
3
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:
1659886935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5515 WIMBLEDON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70131-5325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 FRANKLIN AVE STE A2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70122-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-322-2185
Provider Business Practice Location Address Fax Number:
504-322-2695
Provider Enumeration Date:
12/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
GARIBALDI
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
504-606-2098

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1508268 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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