1699703330 NPI number — COLON & RECTAL ASSOCIATES PC

Table of content: (NPI 1699703330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699703330 NPI number — COLON & RECTAL ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLON & RECTAL ASSOCIATES PC
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:
1699703330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
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 STE 430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71105-5741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-424-8373
Provider Business Mailing Address Fax Number:
318-424-6477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1811 E BERT KOUNS STE 430
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-5741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-424-8373
Provider Business Practice Location Address Fax Number:
318-424-6477
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRIMES
Authorized Official First Name:
W.
Authorized Official Middle Name:
REID
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
318-424-8373

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , 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: 071416401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1107913 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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