1114150174 NPI number — WILKES ENTERPRISES HEALING PLACE MEDICAL CENTER

Table of content: (NPI 1114150174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114150174 NPI number — WILKES ENTERPRISES HEALING PLACE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILKES ENTERPRISES HEALING PLACE MEDICAL CENTER
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:
1114150174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 887
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZACHARY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70791-0887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-658-2036
Provider Business Mailing Address Fax Number:
225-658-9788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6110 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ZACHARY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70791-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-658-2036
Provider Business Practice Location Address Fax Number:
225-658-9788
Provider Enumeration Date:
08/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILKES
Authorized Official First Name:
GRETA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
225-658-2036

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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