1659561082 NPI number — ALAN J BORNE, M D, APMC

Table of content: (NPI 1659561082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659561082 NPI number — ALAN J BORNE, M D, APMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAN J BORNE, M D, APMC
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:
1659561082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1811 E BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Mailing Address:
SUITE 440
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71105-5740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-222-9205
Provider Business Mailing Address Fax Number:
318-222-3625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1811 E BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-5740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-222-9205
Provider Business Practice Location Address Fax Number:
318-222-3625
Provider Enumeration Date:
08/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORNE
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
318-222-9205

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  015022 , 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: 1330701 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0400898 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4386850490 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110043416 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 074222301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 234735300 . This is a "DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".




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