1891846861 NPI number — MEDICAL SPECIALISTS OF NEW ORLEANS, INC

Table of content: JXXN RENEE MONTENEGRO ND (NPI 1922724004)

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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