1083661854 NPI number — A-1 BAYOU HEALTH 2000, INC.

Table of content: (NPI 1083661854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083661854 NPI number — A-1 BAYOU HEALTH 2000, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A-1 BAYOU HEALTH 2000, INC.
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:
1083661854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
826 W HIGHWAY 30 STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GONZALES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70737-4852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-348-3011
Provider Business Mailing Address Fax Number:
985-348-3015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
826 W HWY 30
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
GONZALES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70737-4852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-348-3011
Provider Business Practice Location Address Fax Number:
985-348-3015
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORDELON
Authorized Official First Name:
ROCK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-226-8202

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1403962 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190034432Z . This is a "BCBS OF LOUISIANA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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