1023162096 NPI number — DEPARTMENT OF HEALTH AND HOSPITALS

Table of content: (NPI 1023162096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023162096 NPI number — DEPARTMENT OF HEALTH AND HOSPITALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPARTMENT OF HEALTH AND HOSPITALS
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:
DR. JOSEPH H. TYLER, JR. BEHAVIORAL HEALTH CLINIC
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:
1023162096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 DULLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70506-3008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-262-4100
Provider Business Mailing Address Fax Number:
337-262-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 DULLES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-262-4100
Provider Business Practice Location Address Fax Number:
337-262-4117
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MIRE
Authorized Official First Name:
YANCEY
Authorized Official Middle Name:
Authorized Official Title or Position:
BEHAVIORAL HEALTH DIRECTOR
Authorized Official Telephone Number:
337-262-4100

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  005 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 176 , 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: 1710032 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5HD26 . This is a "MEDICARE PTAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com