1962877654 NPI number — COMPASS GROUP USA, INC. BY & THROUGH ITS BATEMAN DIVISION

Table of content: (NPI 1962877654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962877654 NPI number — COMPASS GROUP USA, INC. BY & THROUGH ITS BATEMAN DIVISION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASS GROUP USA, INC. BY & THROUGH ITS BATEMAN DIVISION
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:
1962877654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3110 W PINHOOK RD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-3453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-593-0433
Provider Business Mailing Address Fax Number:
225-208-1504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
238 S PRESTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARKSVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71351-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-253-5035
Provider Business Practice Location Address Fax Number:
318-253-8336
Provider Enumeration Date:
12/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BRETTLER
Authorized Official First Name:
MAGI
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL VICE PRESIDENT
Authorized Official Telephone Number:
337-593-0433

Provider Taxonomy Codes

  • Taxonomy code: 332U00000X , with the licence number:  007051 , 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: 1346615135 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1801261722 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386068500 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417322207 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053786848 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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