1598723769 NPI number — PLAQUEMINE CARING, LLC

Table of content: PAUL KAZUHIKO AWA MD (NPI 1083655906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598723769 NPI number — PLAQUEMINE CARING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAQUEMINE CARING, 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:
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:
1598723769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59215 RIVER WEST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAQUEMINE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70764-6552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-687-0240
Provider Business Mailing Address Fax Number:
225-687-0249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
59215 RIVER WEST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAQUEMINE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70764-6552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-687-0240
Provider Business Practice Location Address Fax Number:
225-687-0249
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUM
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
225-800-4955

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  441 , 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: 1520080 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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