1972630705 NPI number — NORTH OAKS MEDICAL CENTER, LLC

Table of content: (NPI 1972630705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972630705 NPI number — NORTH OAKS MEDICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH OAKS MEDICAL CENTER, LLC
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:
1972630705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70404-2668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-230-6534
Provider Business Mailing Address Fax Number:
985-230-6653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15790 PAUL VEGA MD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-230-1682
Provider Business Practice Location Address Fax Number:
985-230-1617
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
985-230-6602

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  203 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 703 , 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: 1077759 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 881253 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011720765132 . This is a "CHAMPUS-VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6290355 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 720765132005 . This is a "TRICARE-HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1795879 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201761 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7207651320155 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0041030 . This is a "OGB" identifier . This identifiers is of the category "OTHER".




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