1528398617 NPI number — BITARS SPECIALTY CLINIC, LLC

Table of content: (NPI 1528398617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528398617 NPI number — BITARS SPECIALTY CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BITARS SPECIALTY CLINIC, 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:
1528398617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70459-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-643-0075
Provider Business Mailing Address Fax Number:
985-646-0430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7015 HIGHWAY 190 EAST SERVICE RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-4960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-643-0075
Provider Business Practice Location Address Fax Number:
985-646-0430
Provider Enumeration Date:
01/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BITAR
Authorized Official First Name:
CAMILLE
Authorized Official Middle Name:
NASIM
Authorized Official Title or Position:
OWNER/MD
Authorized Official Telephone Number:
985-774-9113

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  09189R , 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: 1822523 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com