1306878350 NPI number — VERNON INTERNAL MEDICINE CLINIC INC

Table of content: (NPI 1306878350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306878350 NPI number — VERNON INTERNAL MEDICINE CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERNON INTERNAL MEDICINE CLINIC INC
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:
1306878350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
931 VERONE TER
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LEESVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71446-4272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-238-3475
Provider Business Mailing Address Fax Number:
337-238-3475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
931 VERONE TER
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446-4272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-238-3475
Provider Business Practice Location Address Fax Number:
337-238-3475
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UPADHYAY
Authorized Official First Name:
KANCHAN
Authorized Official Middle Name:
PRASAD
Authorized Official Title or Position:
BUISNESS OWNER
Authorized Official Telephone Number:
337-238-3475

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1578924 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0508695280 . This is a "BLUECROSS BLUE SHEILD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 36-00370 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com