1184643736 NPI number — ERIC J SCHULTIS M.D.

Table of content: ERIC J SCHULTIS M.D. (NPI 1184643736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184643736 NPI number — ERIC J SCHULTIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULTIS
Provider First Name:
ERIC
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1184643736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4224 HOUMA BLVD STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-455-7999
Provider Business Mailing Address Fax Number:
504-455-7920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4720 S. I-10 SERVICE RD. W
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70001-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-455-7999
Provider Business Practice Location Address Fax Number:
504-455-7920
Provider Enumeration Date:
07/18/2006

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: 174400000X , with the licence number:  MD104207 , 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: 160009039 . This is a "RR MEDICAF" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1337323 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 423022231A . This is a "BC/BS OF LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 690471 . This is a "AETNA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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