1144504796 NPI number — REBECCA ESKEW CLAWSON PA

Table of content: REBECCA ESKEW CLAWSON PA (NPI 1144504796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144504796 NPI number — REBECCA ESKEW CLAWSON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAWSON
Provider First Name:
REBECCA
Provider Middle Name:
ESKEW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESKEW
Provider Other First Name:
REBECCA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144504796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 33932
Provider Second Line Business Mailing Address:
SAHP PA PROGRAM
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71130-3932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-813-2927
Provider Business Mailing Address Fax Number:
318-813-2915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 KINGS HWY
Provider Second Line Business Practice Location Address:
SAHP PA PROGRAM
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-813-2927
Provider Business Practice Location Address Fax Number:
318-813-2915
Provider Enumeration Date:
09/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA.200481 , 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: 2182960 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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