1336288752 NPI number — L THOMAS CASHIO MD & MARK JUNEAU JR MD,PC

Table of content: (NPI 1336288752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336288752 NPI number — L THOMAS CASHIO MD & MARK JUNEAU JR MD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L THOMAS CASHIO MD & MARK JUNEAU JR MD,PC
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:
1336288752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/26/2023
NPI Reactivation Date:
10/24/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 AVENUE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARRERO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70072-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-349-6804
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 AVENUE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARRERO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70072-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-349-6804
Provider Business Practice Location Address Fax Number:
504-349-6844
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WAX
Authorized Official First Name:
BARTON
Authorized Official Middle Name:
LLOYD
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
504-579-6945

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1792217 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK4990 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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