1780637223 NPI number — LOUISIANA INSTITUTE OF PHYSICAL MEDICINE & FAMILY PRACTICE

Table of content: (NPI 1780637223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780637223 NPI number — LOUISIANA INSTITUTE OF PHYSICAL MEDICINE & FAMILY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA INSTITUTE OF PHYSICAL MEDICINE & FAMILY PRACTICE
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:
1780637223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-766-1616
Provider Business Mailing Address Fax Number:
225-766-2645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8338 SUMMA AVE
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-3669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-766-1616
Provider Business Practice Location Address Fax Number:
225-766-2645
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
225-766-1616

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  08510R , 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: 174480700 . This is a "ACS-DEPT OF LABOR" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: G1573 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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