1851458467 NPI number — DRS CHISHOLM HARRISON SANDIFER

Table of content: (NPI 1851458467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851458467 NPI number — DRS CHISHOLM HARRISON SANDIFER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS CHISHOLM HARRISON SANDIFER
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:
GEORGE HARRISON WILLIAM CHISHOLM ALAN SANDIFER
Provider Other Organization Name Type Code:
3
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:
1851458467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6721 GOVERNMENT ST
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-923-2160
Provider Business Mailing Address Fax Number:
225-923-3009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6721 GOVERNMENT ST
Provider Second Line Business Practice Location Address:
STE D
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-923-2160
Provider Business Practice Location Address Fax Number:
225-923-3009
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER PARTNER
Authorized Official Telephone Number:
225-923-2160

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  4584 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223E0200X , with the licence number: 3158 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X , with the licence number: 3128 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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