1720256662 NPI number — VASOCARE LLC

Table of content: (NPI 1720256662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720256662 NPI number — VASOCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASOCARE 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:
1720256662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14933
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:
70898-4933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-924-0444
Provider Business Mailing Address Fax Number:
866-455-5150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6554 FLORIDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 123
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-4474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-924-0444
Provider Business Practice Location Address Fax Number:
866-455-5150
Provider Enumeration Date:
02/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BERGES
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
225-924-0444

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 1372676 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com