1164700944 NPI number — CALVIN WALKER MD, LLC

Table of content: PAMELA HINES (NPI 1093283244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164700944 NPI number — CALVIN WALKER MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALVIN WALKER MD, 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:
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:
1164700944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3418 MEDICAL PARK DR
Provider Second Line Business Mailing Address:
SUITE 24
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71203-2376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-323-0700
Provider Business Mailing Address Fax Number:
318-323-9983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3418 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 24
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71203-2376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-323-0700
Provider Business Practice Location Address Fax Number:
318-323-9983
Provider Enumeration Date:
07/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
CALVIN
Authorized Official Middle Name:
CECIL
Authorized Official Title or Position:
MEMBER OF LLC
Authorized Official Telephone Number:
318-323-0700

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  07177R , 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: 52284 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1363341 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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