1154976157 NPI number — JOSEPH E HUMBLE AND RAYMOND HAIK, PTRS

Table of content: (NPI 1154976157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154976157 NPI number — JOSEPH E HUMBLE AND RAYMOND HAIK, PTRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH E HUMBLE AND RAYMOND HAIK, PTRS
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:
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:
1154976157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 N 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71291-4414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-325-2610
Provider Business Mailing Address Fax Number:
318-325-7715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 CHRISTIAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71269-3645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-728-2020
Provider Business Practice Location Address Fax Number:
318-728-5284
Provider Enumeration Date:
08/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HUMBLE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
ELGIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-325-2610

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0407850001 . This is a "DME SUPPLIER #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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