1255490603 NPI number — LEADER BALKAN & HENDRICKS APMC

Table of content: (NPI 1255490603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255490603 NPI number — LEADER BALKAN & HENDRICKS APMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEADER BALKAN & HENDRICKS 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:
6
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:
1255490603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 HOUMA BLVD
Provider Second Line Business Mailing Address:
SUITE 216
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-2930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-454-0758
Provider Business Mailing Address Fax Number:
504-454-0167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3434 PRYTANIA ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70115-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-891-1988
Provider Business Practice Location Address Fax Number:
504-899-1895
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEADER
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
MD PARTNER
Authorized Official Telephone Number:
504-454-0158

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1948781 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI2603 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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