1730189952 NPI number — MOSHOOD OLATINWO MD

Table of content: MOSHOOD OLATINWO MD (NPI 1730189952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730189952 NPI number — MOSHOOD OLATINWO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLATINWO
Provider First Name:
MOSHOOD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1730189952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
617A BIENVILLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATCHITOCHES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71457-5730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-352-1108
Provider Business Mailing Address Fax Number:
318-352-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
617A BIENVILLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATCHITOCHES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71457-5730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-352-1108
Provider Business Practice Location Address Fax Number:
318-352-1106
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD.203547 , 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: 009911284 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09001250 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2100882 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000973233 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515542695 . This is a "BCBS - 1720 CENTER ST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51542720 . This is a "BCBS - 1610 CENTER ST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009911291 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com