1609919521 NPI number — DIRECT MEDS PLUS INC

Table of content: (NPI 1609919521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609919521 NPI number — DIRECT MEDS PLUS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIRECT MEDS PLUS 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:
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:
1609919521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10319 MAMMOTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70814-4425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-910-8874
Provider Business Mailing Address Fax Number:
800-840-6121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10319 MAMMOTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70814-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-910-8874
Provider Business Practice Location Address Fax Number:
800-840-6121
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILSEY
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
225-910-8874

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  10-00524-504 , 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: 1536776 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G0879 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com