1255894952 NPI number — EAST BATON ROUGE EMERGENCY PHYSICIANS GROUP, LLC

Table of content: CIERRIA ESTAVONNE NASH LVN (NPI 1700687779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255894952 NPI number — EAST BATON ROUGE EMERGENCY PHYSICIANS GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST BATON ROUGE EMERGENCY PHYSICIANS GROUP, 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:
1255894952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 721631
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070-8253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-240-9381
Provider Business Mailing Address Fax Number:
337-534-0953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZACHARY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70791-4037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-658-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PROVOST
Authorized Official First Name:
AMY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
337-534-0952

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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