1962641076 NPI number — PREVENTIVE MEASURES PROGRAMS, IN.,

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 1962641076 NPI number — PREVENTIVE MEASURES PROGRAMS, IN.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREVENTIVE MEASURES PROGRAMS, IN.,
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:
1962641076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71211-9177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-574-0098
Provider Business Mailing Address Fax Number:
318-574-1208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 SNYDER ST STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLULAH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71282-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-574-0098
Provider Business Practice Location Address Fax Number:
138-574-1208
Provider Enumeration Date:
02/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-614-5445

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  PCA 15154 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: SIL 20123 , 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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