1952099038 NPI number — MARY ELIZABETH LABATUT PST.013632

Table of content: MARY ELIZABETH LABATUT PST.013632 (NPI 1952099038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952099038 NPI number — MARY ELIZABETH LABATUT PST.013632

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABATUT
Provider First Name:
MARY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PST.013632
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LABATUT
Provider Other First Name:
MARY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1952099038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7717 LA HIGHWAY 418
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATCHELOR
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70715-3415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-718-3984
Provider Business Mailing Address Fax Number:
225-655-2725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17544 TUNICA TRCE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANGOLA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70712-3029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-655-2307
Provider Business Practice Location Address Fax Number:
225-655-2725
Provider Enumeration Date:
04/27/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PST.013632 , 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)





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