1649516261 NPI number — PRACTICARE, LLC

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 1649516261 NPI number — PRACTICARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRACTICARE, 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:
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:
1649516261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
597 TUNICA DRIVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARKSVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-253-0866
Provider Business Mailing Address Fax Number:
318-253-0864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7406 HIGHWAY 1 STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSURA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71350-4230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-739-0086
Provider Business Practice Location Address Fax Number:
877-325-2708
Provider Enumeration Date:
12/31/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUCOTE
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-739-0086

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2327950 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".