Basic Information
| Provider Information | |||||||||
| NPI: | 1053395988 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YOUNGBLOOD | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1918 WILLIAMS BLVD. | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL CENTER KENNER, LLC | ||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044714860 | ||||||||
| FaxNumber: | 5049109371 | ||||||||
| Practice Location | |||||||||
| Address1: | 1918 WILLIAMS BLVD. | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL CENTER KENNER, LLC | ||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044714860 | ||||||||
| FaxNumber: | 5049109371 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 11/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD.200196 | LA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 200196 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD200196 | 01 | LA | STATE MEDICAL LICENSE | OTHER | 1626970 | 05 | LA | MEDICAID |