1346376076 NPI number — CLINIC OF EAR NOSE THROAT & NECK

Table of content: MRS. RACHEL NAA AKLEH DODOO (NPI 1932421369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346376076 NPI number — CLINIC OF EAR NOSE THROAT & NECK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINIC OF EAR NOSE THROAT & NECK
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:
1346376076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 COLONIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-927-5325
Provider Business Mailing Address Fax Number:
225-927-4150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 COLONIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-6511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-927-5325
Provider Business Practice Location Address Fax Number:
225-927-4150
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
IRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE
Authorized Official Telephone Number:
225-927-5325

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , 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: 1793493 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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