1538113741 NPI number — SHELLY N SAVANT MD,LLC

Table of content: (NPI 1538113741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538113741 NPI number — SHELLY N SAVANT MD,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELLY N SAVANT MD,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:
1538113741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 73701
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70033-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-639-8811
Provider Business Mailing Address Fax Number:
985-781-1819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 ANDRE ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
NEW IBERIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70563-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-365-6797
Provider Business Practice Location Address Fax Number:
337-560-4517
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KASTNER
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING ADMINISTRATOR
Authorized Official Telephone Number:
985-639-8811

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  025564 , 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: 1556360 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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