1548656465 NPI number — EVANGELINE CLINICAL SERVICES, INC.

Table of content: (NPI 1548656465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548656465 NPI number — EVANGELINE CLINICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVANGELINE CLINICAL SERVICES, INC.
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:
6
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:
1548656465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
855 PIERREMONT RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71106-2084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-861-7413
Provider Business Mailing Address Fax Number:
318-865-5792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 PIERREMONT RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71106-2084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-861-7413
Provider Business Practice Location Address Fax Number:
318-865-5792
Provider Enumeration Date:
04/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MERRYMAN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
318-561-7188

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1200X ; 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