1639373889 NPI number — AVOYELLES SURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL LLC

Table of content: (NPI 1639373889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639373889 NPI number — AVOYELLES SURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVOYELLES SURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1639373889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4239 HIGHWAY 1192
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MARKSVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71351-4771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-253-7767
Provider Business Mailing Address Fax Number:
318-253-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4239 HIGHWAY 1192
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MARKSVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71351-4711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-253-7767
Provider Business Practice Location Address Fax Number:
318-253-7756
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORDELON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
GENERAL SURGEON
Authorized Official Telephone Number:
318-253-7767

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD.201214 , 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)





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