1376716373 NPI number — CHERILYNNE T. COTTLES M.D.MEDICAL CORPORATION

Table of content: (NPI 1376716373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376716373 NPI number — CHERILYNNE T. COTTLES M.D.MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHERILYNNE T. COTTLES M.D.MEDICAL CORPORATION
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:
1376716373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7422
Provider Second Line Business Mailing Address:
P.O.BOX 7422
Provider Business Mailing Address City Name:
NATCHITOCHES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71457-0422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-238-5900
Provider Business Mailing Address Fax Number:
318-238-5901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327A SOUTH DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATCHITOCHES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-238-5900
Provider Business Practice Location Address Fax Number:
318-238-5901
Provider Enumeration Date:
04/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COTTLES
Authorized Official First Name:
CHERILYNNE
Authorized Official Middle Name:
TONI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-238-5900

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305R00000X , with the licence number: 16920 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com