1760428791 NPI number — THOMAS J ENTERPRISES INC

Table of content: (NPI 1760428791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760428791 NPI number — THOMAS J ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS J ENTERPRISES INC
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:
1760428791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11436 S SAINT ANDREWS CIR
Provider Second Line Business Mailing Address:
CIRCLE
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70128-5220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-274-9972
Provider Business Mailing Address Fax Number:
504-267-3409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 WESTBANK EXPY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70053-5642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-267-3029
Provider Business Practice Location Address Fax Number:
504-267-3409
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
DAU
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
504-274-9972

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY 004212-IR , 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: 1266981 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1928918 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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