1891846861 NPI number — MEDICAL SPECIALISTS OF NEW ORLEANS, INC

Table of content: (NPI 1891846861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891846861 NPI number — MEDICAL SPECIALISTS OF NEW ORLEANS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL SPECIALISTS OF NEW ORLEANS, 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:
1891846861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3525 PRYTANIA ST
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70115-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-897-4017
Provider Business Mailing Address Fax Number:
504-899-6775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1206 J W DAVIS DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-5953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-897-4017
Provider Business Practice Location Address Fax Number:
504-899-6775
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EAGLIN
Authorized Official First Name:
PAIGE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
504-897-4017

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  075450 , 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: 1444171 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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