1952731580 NPI number — J. DONALD PERSICH

Table of content: (NPI 1952731580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952731580 NPI number — J. DONALD PERSICH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J. DONALD PERSICH
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:
1952731580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4609 GARY MIKEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70002-1459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-887-5010
Provider Business Mailing Address Fax Number:
504-734-3509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 S. CLEARVIEW PKWY, FOURTH FLOOR
Provider Second Line Business Practice Location Address:
CANON HOSPICE
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-818-2723
Provider Business Practice Location Address Fax Number:
504-734-3509
Provider Enumeration Date:
11/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MAY
Authorized Official First Name:
SUE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
504-729-6920

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 006826 . This is a "MEDICAL LICENSE NUMBER STATE OF LOUISIANA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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