1881027175 NPI number — BIANCHINI SPENCER

Table of content: (NPI 1881027175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881027175 NPI number — BIANCHINI SPENCER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIANCHINI SPENCER
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:
1881027175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 N I 10 SERVICE RD E
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70002-6137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-780-1702
Provider Business Mailing Address Fax Number:
504-780-1705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 N I 10 SERVICE RD E
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002-6137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-780-1702
Provider Business Practice Location Address Fax Number:
504-780-1705
Provider Enumeration Date:
08/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SPENCER
Authorized Official First Name:
TRESA
Authorized Official Middle Name:
ROEBUCK
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
504-780-1702

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  1246 , 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)





Copyright © 2007-2025 www.npivalidator.com