1215014634 NPI number — MEDICAL ADVANTAGE CARE, L.L.C.

Table of content: (NPI 1215014634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215014634 NPI number — MEDICAL ADVANTAGE CARE, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ADVANTAGE CARE, L.L.C.
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:
1215014634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70501-7163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-269-1629
Provider Business Mailing Address Fax Number:
337-269-1628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70501-7163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-269-1629
Provider Business Practice Location Address Fax Number:
337-269-1628
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVIER
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
PROVOST
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
337-269-1629

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  11345 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , with the licence number: 11344 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , with the licence number: 11347 , 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: 1188328 . This is a "RESPITE PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1142883 . This is a "SIL PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1188336 . This is a "PCA PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1171824 . This is a "PCS PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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