1881628113 NPI number — WEST MONROE GUEST HOUSE, INC.

Table of content: DR. EDWARD WEI CHI LIU M.D. (NPI 1871587683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881628113 NPI number — WEST MONROE GUEST HOUSE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST MONROE GUEST HOUSE, 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:
1881628113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71210-3068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-361-9555
Provider Business Mailing Address Fax Number:
318-361-0740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 GUEST HOUSE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71292-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-387-3900
Provider Business Practice Location Address Fax Number:
318-361-0740
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROUNSAVILLE
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
318-361-9555

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2203781583 , 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: 1514357 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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