1710076641 NPI number — EAST BATON ROUGE MEDICAL CENTER, LLC

Table of content: PATRICK ALLEN FEWINS MD (NPI 1376273532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710076641 NPI number — EAST BATON ROUGE MEDICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST BATON ROUGE MEDICAL CENTER, 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:
1710076641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17000 MEDICAL CENTER DR
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:
70816-3246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-752-2470
Provider Business Mailing Address Fax Number:
225-755-4915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17000 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-3246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-752-2470
Provider Business Practice Location Address Fax Number:
225-755-4915
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PFS DIRECTOR
Authorized Official Telephone Number:
225-752-2470

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60909 . This is a "BLUE CROSS GEROPSY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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