1669926887 NPI number — KINDL WORKS LLC

Table of content: (NPI 1669926887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669926887 NPI number — KINDL WORKS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINDL WORKS 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:
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:
1669926887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1570 LINDBERG DR
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70458-8083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-326-8614
Provider Business Mailing Address Fax Number:
985-445-1603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1570 LINDBERG DR STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-326-8614
Provider Business Practice Location Address Fax Number:
985-445-1603
Provider Enumeration Date:
08/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ROIG
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
985-326-8614

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1055492 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01154595 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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