1982738258 NPI number — MRS. MONEE BYERS SHERIDAN LOTR

Table of content: MRS. MONEE BYERS SHERIDAN LOTR (NPI 1982738258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982738258 NPI number — MRS. MONEE BYERS SHERIDAN LOTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERIDAN
Provider First Name:
MONEE
Provider Middle Name:
BYERS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LOTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BYERS
Provider Other First Name:
MONEE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LOTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982738258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2118
Provider Second Line Business Mailing Address:
5640 HILLTOP CIRCLE
Provider Business Mailing Address City Name:
SAINT FRANCISVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70775-2118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-351-2047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5640 HILLTOP CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT FRANCISVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70775-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-351-2047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2007

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: 174400000X , with the licence number:  Z11811 , 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: 1308668 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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