1730235417 NPI number — ADVANCED HAND SPECIALISTS

Table of content: (NPI 1730235417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730235417 NPI number — ADVANCED HAND SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED HAND SPECIALISTS
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:
1730235417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
594 ASBURY DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70471-4101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-674-4170
Provider Business Mailing Address Fax Number:
985-674-4172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
594 ASBURY DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70471-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-674-4170
Provider Business Practice Location Address Fax Number:
985-674-4172
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCMILLAN
Authorized Official First Name:
CHUCK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
985-674-4170

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  Z10781 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 18412884404 . This is a "HYMEL'S NPI NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1598952640 . This is a "NPI - DAVID MYERS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1114944634 . This is a "AHS CLINIC NPI NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1972591006 . This is a "SMITH'S NPI NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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