1639124415 NPI number — M.M. ACCUMED VENTURES, LLC

Table of content: (NPI 1639124415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639124415 NPI number — M.M. ACCUMED VENTURES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M.M. ACCUMED VENTURES, 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:
1639124415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 S SHERWOOD FOREST BLVD
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:
70816-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-292-2031
Provider Business Mailing Address Fax Number:
225-295-9678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 S I H 35
Provider Second Line Business Practice Location Address:
STE 215
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-5712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-330-9444
Provider Business Practice Location Address Fax Number:
512-732-0206
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORNE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
225-292-2031

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  009592 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 014868 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 679116 . This is a "STERLING LIFE INSURANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 679122 . This is a "PACIFICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 679116 . This is a "HUMANA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 724988423 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 152732702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 724977423 . This is a "HUMANA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 679116 . This is a "ARCADIAN HEALTH PLAN HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH136H . This is a "BC BS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 152732701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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