1922286269 NPI number — ORA TREADWAY

Table of content: (NPI 1922286269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922286269 NPI number — ORA TREADWAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORA TREADWAY
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:
1922286269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
808 N 31ST ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201-3941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-410-0900
Provider Business Mailing Address Fax Number:
318-410-0901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 N 31ST ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-3941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-410-0900
Provider Business Practice Location Address Fax Number:
318-410-0901
Provider Enumeration Date:
02/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TREADWAY
Authorized Official First Name:
ORA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
318-410-0900

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  PCA10922 , 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: 1017191 . This is a "EDA WAIVER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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