1932470887 NPI number — ADVANCED NORTHSHORE NEUROSURGICAL INSTITUTE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932470887 NPI number — ADVANCED NORTHSHORE NEUROSURGICAL INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED NORTHSHORE NEUROSURGICAL INSTITUTE
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:
1932470887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71380 HIGHWAY 21
Provider Second Line Business Mailing Address:
104
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70433-7245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-400-3210
Provider Business Mailing Address Fax Number:
855-553-6931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71380 HIGHWAY 21
Provider Second Line Business Practice Location Address:
104
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-7245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-400-3210
Provider Business Practice Location Address Fax Number:
855-553-6931
Provider Enumeration Date:
01/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ALMUBASLAT
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER MEMBER
Authorized Official Telephone Number:
985-400-3210

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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