1275700189 NPI number — UNITED MEDICAL HEALTHWEST NEW ORLEANS LLC

Table of content: (NPI 1275700189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275700189 NPI number — UNITED MEDICAL HEALTHWEST NEW ORLEANS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED MEDICAL HEALTHWEST NEW ORLEANS 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:
UNITED MEDICAL HEALTHWEST
Provider Other Organization Name Type Code:
3
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:
1275700189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3201 B WALL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70056-7755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-433-5551
Provider Business Mailing Address Fax Number:
504-433-5535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 B WALL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-7755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-433-5551
Provider Business Practice Location Address Fax Number:
504-433-5535
Provider Enumeration Date:
05/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILLS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
504-433-5551

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  622 , 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: 1700223 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 193074 . This is a "MEDICARE ID-TYPE UNSPECIFIED IRF" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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