Basic Information
| Provider Information | |||||||||
| NPI: | 1407161250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NES LOUISIANA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 402465 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303842465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043778721 | ||||||||
| FaxNumber: | 3046971155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLINTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704383688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858394431 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2010 | ||||||||
| LastUpdateDate: | 04/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4154354591 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 08502898 | 05 | MS | MEDICAID | 2142321 | 05 | LA | MEDICAID | DR4129 | 01 | RR MEDICARE | OTHER | 1900G6438Z | 01 | LA | BCBS | OTHER |