1023340254 NPI number — WOMEN'S CLINIC OF OAKDALE, LLC

Table of content: (NPI 1023340254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023340254 NPI number — WOMEN'S CLINIC OF OAKDALE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S CLINIC OF OAKDALE, 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:
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:
1023340254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 CHERRY ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MAMOU
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70554-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-468-2250
Provider Business Mailing Address Fax Number:
337-468-2702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71463-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-335-0260
Provider Business Practice Location Address Fax Number:
318-335-3356
Provider Enumeration Date:
02/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KULKARNI
Authorized Official First Name:
MEDHA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
337-468-2250

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  05120R , 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: 2121014 . This is a "AMERIGROUP CCN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 53433DM43 . This is a "GROUP MEMBER PTAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 19-3898 . This is a "MEDICAE PART A" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2121014 . This is a "UNITED HEALTHCARE CCN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2121014 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5DM43 . This is a "MEDICARE PTAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2121014 . This is a "COMMUNITY HEALTH SOLUTIONS CCN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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