1861693962 NPI number — SOLUTIONS MEDICAL CONSULTING, LLC

Table of content: (NPI 1861693962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861693962 NPI number — SOLUTIONS MEDICAL CONSULTING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLUTIONS MEDICAL CONSULTING, LLC
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:
SERENITY SPRINGS SPECIALTY HOSPITAL
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:
1861693962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2404 DUVAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201-2986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-329-3933
Provider Business Mailing Address Fax Number:
318-322-1134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1495 FRAZIER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71270-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-202-3860
Provider Business Practice Location Address Fax Number:
318-202-5860
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROADWAY
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
318-202-3860

Provider Taxonomy Codes

  • Taxonomy code: 207PE0005X , with the licence number:  107598 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X , with the licence number: 686 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: APO5233 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 06192 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 04743 , 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)

  • Identifier: 1705865 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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