1619099231 NPI number — MRS. DEBRA INEZ WELCH A.B.O.C. AMERICAN BO

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 1619099231 NPI number — MRS. DEBRA INEZ WELCH A.B.O.C. AMERICAN BO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELCH
Provider First Name:
DEBRA
Provider Middle Name:
INEZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
A.B.O.C. AMERICAN BO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELCH
Provider Other First Name:
DEBRA
Provider Other Middle Name:
DOYLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
A.B.O.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619099231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1509 A. NORTH PINE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERIDDER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70634-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-463-9821
Provider Business Mailing Address Fax Number:
337-463-9821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 A. NORTH PINE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERIDDER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70634-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-463-9821
Provider Business Practice Location Address Fax Number:
337-463-9821
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  ABO CERTIFIED 21999 , 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: 1569178 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619099231 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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