1023732625 NPI number — DR. TODD S. BRASUELL LLC

Table of content: (NPI 1023732625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023732625 NPI number — DR. TODD S. BRASUELL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. TODD S. BRASUELL 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:
6
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:
1023732625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
189 GREENBRIER BLVD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70433-7297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-892-5942
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
189 GREENBRIER BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-7297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-892-5942
Provider Business Practice Location Address Fax Number:
985-892-8996
Provider Enumeration Date:
09/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MARGIOTTA
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
985-892-5942

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1855502 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com