1033383906 NPI number — MILLENNIUM HEALTH CARE SERVICES

Table of content: (NPI 1033383906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033383906 NPI number — MILLENNIUM HEALTH CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLENNIUM HEALTH CARE SERVICES
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:
1033383906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70895-4301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-923-3117
Provider Business Mailing Address Fax Number:
225-923-3118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 JOHNSTON ST
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-264-1288
Provider Business Practice Location Address Fax Number:
337-264-1289
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WOODS
Authorized Official First Name:
DWAINE
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
225-923-3117

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X , with the licence number:  PCA 7051 , 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: 1008761 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com