1487845665 NPI number — DR. JAIME MARGUERITE EDWARDS MD

Table of content: DR. JAIME MARGUERITE EDWARDS MD (NPI 1487845665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487845665 NPI number — DR. JAIME MARGUERITE EDWARDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
JAIME
Provider Middle Name:
MARGUERITE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1487845665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3087
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70404-3087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-230-1682
Provider Business Mailing Address Fax Number:
985-230-6652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15813 PAUL VEGA MD DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-1495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-230-7650
Provider Business Practice Location Address Fax Number:
985-230-7655
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  BP10029595 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: MD.205009 , 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: 2174185 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4664134417 . This is a "MYUTMB 4664134417" identifier . This identifiers is of the category "OTHER".




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