1619035706 NPI number — LEONARD P. NEUMANN JR MD A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1619035706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619035706 NPI number — LEONARD P. NEUMANN JR MD A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONARD P. NEUMANN JR MD A PROFESSIONAL MEDICAL CORPORATION
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:
1619035706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLULAH
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71284-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-574-4731
Provider Business Mailing Address Fax Number:
318-574-4739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 JOHNSON ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLULAH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71282-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-574-4731
Provider Business Practice Location Address Fax Number:
318-574-4739
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEUMANN
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
318-574-4731

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  012193 , 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: 4336215270 . This is a "BLUE CROSS OF LA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 827113052 . This is a "PALMETTO GBA RAILROAD MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1198579 . This is a "MEDICAID INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54420 . This is a "MEDICARE INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1948497 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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