1184089492 NPI number — PAISLEY FAMILY MEDICAL CENTER, LLC

Table of content: (NPI 1184089492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184089492 NPI number — PAISLEY FAMILY MEDICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAISLEY FAMILY MEDICAL CENTER, 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:
1184089492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4910 HOWARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70125-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-390-0539
Provider Business Mailing Address Fax Number:
504-322-2622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 ELYSIAN FIELDS AVE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70122-7403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-962-9705
Provider Business Practice Location Address Fax Number:
504-962-9707
Provider Enumeration Date:
12/31/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BARCONEY
Authorized Official First Name:
MONIQUE
Authorized Official Middle Name:
DANNETTE
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
504-962-9705

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP04742 , 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: 2412108 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1032239 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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