1487253407 NPI number — OCHSNER MISSISSIPPI, LLC

Table of content: (NPI 1487253407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487253407 NPI number — OCHSNER MISSISSIPPI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCHSNER MISSISSIPPI, 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:
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:
1487253407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 DRINKWATER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SAINT LOUIS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39520-1658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
906 SIXTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICAYUNE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39466-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-798-7529
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BENITEZ
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
504-430-0025

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09627255 . This is a "MEDICAID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com