1720729833 NPI number — PEACE MANAGEMENT INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720729833 NPI number — PEACE MANAGEMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEACE MANAGEMENT INC
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:
1720729833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16237 HIGHWAY 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMMESPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71369-2157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-941-2423
Provider Business Mailing Address Fax Number:
318-941-2549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16237 HIGHWAY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMMESPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-941-2423
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BARBIN
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF PHARMACIST
Authorized Official Telephone Number:
318-941-2423

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1925811 . This is a "NABP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1255491783 . This is a "RETAIL NPI" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2208373 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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