1174703789 NPI number — ROSEMARIE JACK CAILLIER,DPM

Table of content: (NPI 1174703789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174703789 NPI number — ROSEMARIE JACK CAILLIER,DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSEMARIE JACK CAILLIER,DPM
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:
1174703789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84433
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:
70884-4433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-295-1900
Provider Business Mailing Address Fax Number:
225-295-1906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5516 SUPERIOR DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-8022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-295-1900
Provider Business Practice Location Address Fax Number:
225-295-1906
Provider Enumeration Date:
11/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAILLIER
Authorized Official First Name:
ROSEMARIE
Authorized Official Middle Name:
JACK
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
225-295-1900

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  DPMPD227R , 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: 4730320001 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 156430 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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