1134380819 NPI number — R A HOLDINGS LLC

Table of content: (NPI 1134380819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134380819 NPI number — R A HOLDINGS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R A HOLDINGS 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:
1134380819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15271
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:
70895-5271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-922-8377
Provider Business Mailing Address Fax Number:
225-930-0260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8894 AIRLINE HWY
Provider Second Line Business Practice Location Address:
SUITE Q
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70815-4081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-922-8377
Provider Business Practice Location Address Fax Number:
225-930-0260
Provider Enumeration Date:
06/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREWS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
225-922-8377

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  023298 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 023298 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1490181 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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