1861466450 NPI number — ERIC EHRENSING, MD APC

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 1861466450 NPI number — ERIC EHRENSING, MD APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIC EHRENSING, MD APC
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:
1861466450
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:
397 HIGHWAY 21
Provider Second Line Business Mailing Address:
SUITE 601
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70447-3407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-845-9000
Provider Business Mailing Address Fax Number:
985-845-9003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
397 HIGHWAY 21
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70447-3407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-845-9000
Provider Business Practice Location Address Fax Number:
985-845-9003
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OSER
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
985-845-9000

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1430731 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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