Basic Information
Provider Information | |||||||||
NPI: | 1245434224 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ADMINISTRATORS OF THE TULANE EDUCATIONAL FUND | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | TULANE UNIVERSITY MEDICAL CENTER NORTHSHORE CLINICS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1430 TULANE AVE | ||||||||
Address2: | TW22 | ||||||||
City: | NEW ORLEANS | ||||||||
State: | LA | ||||||||
PostalCode: | 701122632 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5049882300 | ||||||||
FaxNumber: | 5049883969 | ||||||||
Practice Location | |||||||||
Address1: | 71211 HIGHWAY 21 | ||||||||
Address2: | SUITE A | ||||||||
City: | COVINGTON | ||||||||
State: | LA | ||||||||
PostalCode: | 704337121 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5049882300 | ||||||||
FaxNumber: | 5049887795 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/13/2007 | ||||||||
LastUpdateDate: | 12/17/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WILLIAMS | ||||||||
AuthorizedOfficialFirstName: | RITA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR, TULANE UNIV. BUS. SERVS | ||||||||
AuthorizedOfficialTelephone: | 5049883587 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 5C132 | 01 | LA | LA MCARE GROUP PROVIDER # | OTHER |