1215103445 NPI number — BEN A. VIERRA, APMC

Table of content: (NPI 1215103445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215103445 NPI number — BEN A. VIERRA, APMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEN A. VIERRA, APMC
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:
1215103445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 WEST ST MARY BLVD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-232-3576
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 WEST ST MARY BLVD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-232-3576
Provider Business Practice Location Address Fax Number:
337-233-2816
Provider Enumeration Date:
05/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRIZZAFFI
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
RYAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
337-232-3576

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP1100X , with the licence number: DPM.PD034R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)