1952526758 NPI number — GLD SERVICES, LLC

Table of content: (NPI 1952526758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952526758 NPI number — GLD SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLD SERVICES, 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:
GORDON DUBOIS DC
Provider Other Organization Name Type Code:
5
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:
1952526758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 750400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-861-7167
Provider Business Mailing Address Fax Number:
504-861-7168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7605 MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70118-5047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-861-7167
Provider Business Practice Location Address Fax Number:
504-861-7168
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUBOIS
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT DOCTOR
Authorized Official Telephone Number:
504-905-9985

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1007 , 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: 4825650360 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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