1669428140 NPI number — MMO OF COVINGTON, LLC

Table of content: IAN CAMERON DROBISH MD (NPI 1811494420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669428140 NPI number — MMO OF COVINGTON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MMO OF COVINGTON, 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:
Provider Other Organization Name Type Code:
6
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:
1669428140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
728 NORTH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70802-5724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-293-6774
Provider Business Mailing Address Fax Number:
225-291-9229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 GREENBRIAR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-7236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-249-7780
Provider Business Practice Location Address Fax Number:
985-249-7782
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
EXECUTIVE OFFICER
Authorized Official Telephone Number:
225-293-6774

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  194701 , 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: 8303 . This is a "OCCUPATIONAL LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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