1750445508 NPI number — ANN THERESA RUDAT AUD

Table of content: ANN THERESA RUDAT AUD (NPI 1750445508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750445508 NPI number — ANN THERESA RUDAT AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDAT
Provider First Name:
ANN
Provider Middle Name:
THERESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

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:
1750445508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7572 KURTHWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1585 3RD ST BJACH
Provider Second Line Business Practice Location Address:
EENT CLINIC
Provider Business Practice Location Address City Name:
FT. POLK
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-531-3297
Provider Business Practice Location Address Fax Number:
337-531-3290
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AT001159-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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