1841351616 NPI number — PHILIP BEARD

Table of content: PAUL ROBERT ELSASSER LICSW (NPI 1083075956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841351616 NPI number — PHILIP BEARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP BEARD
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:
1841351616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OBERLIN
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70655-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-639-4367
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 WEST 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OBERLIN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70655-0189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-639-4367
Provider Business Practice Location Address Fax Number:
337-639-4202
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEARD
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
337-639-4367

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY002488IR , 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: 1259969 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2032636 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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