1558791558 NPI number — MEDICAL PRACTICE MANAGEMENT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558791558 NPI number — MEDICAL PRACTICE MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL PRACTICE MANAGEMENT, 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:
1558791558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71380 HIGHWAY 21
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70433-7245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-893-6080
Provider Business Mailing Address Fax Number:
985-893-6090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71380 HIGHWAY 21
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-7245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-893-6080
Provider Business Practice Location Address Fax Number:
985-893-6090
Provider Enumeration Date:
11/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
THAO
Authorized Official Title or Position:
MEMBER MANAGER
Authorized Official Telephone Number:
985-893-6080

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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