1235259326 NPI number — ASCENSION OPEN MRI, LLC.

Table of content: DR. MOHAMMAD WAHEDUR RAHMAN D.D.S (NPI 1700924362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235259326 NPI number — ASCENSION OPEN MRI, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION OPEN MRI, 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:
1235259326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14149
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:
70898-4149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-450-6125
Provider Business Mailing Address Fax Number:
225-450-6327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2622 SOUTH RUBY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GONZALES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-450-6125
Provider Business Practice Location Address Fax Number:
225-450-6327
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GAUTHIER
Authorized Official First Name:
TAMRA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
225-930-0060

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1029742 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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