1700152212 NPI number — EPLUS ONCOLOGICS MISSISSIPPI, LLC

Table of content: (NPI 1700152212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700152212 NPI number — EPLUS ONCOLOGICS MISSISSIPPI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPLUS ONCOLOGICS MISSISSIPPI, 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:
1700152212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
917 GENERAL MOUTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70501-8511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-237-2057
Provider Business Mailing Address Fax Number:
337-264-1029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 S 13TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39440-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-425-2999
Provider Business Practice Location Address Fax Number:
601-425-3286
Provider Enumeration Date:
03/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BRELAND
Authorized Official First Name:
LADONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMIN LEAD
Authorized Official Telephone Number:
601-425-2999

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09013614 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com