Basic Information
Provider Information | |||||||||
NPI: | 1578679650 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STRICKLAND | ||||||||
FirstName: | THEODORE | ||||||||
MiddleName: | CLIFFORD | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | III | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 106 STELLA ST | ||||||||
Address2: |   | ||||||||
City: | METAIRIE | ||||||||
State: | LA | ||||||||
PostalCode: | 700054542 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5048329039 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1415 TULANE AVE | ||||||||
Address2: | ANESTHESIA DEPT. | ||||||||
City: | NEW ORLEANS | ||||||||
State: | LA | ||||||||
PostalCode: | 701122600 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5049885800 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/22/2006 | ||||||||
LastUpdateDate: | 10/18/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 20729 | LA | N |   | Other Service Providers | Specialist |   | 207L00000X | MD.021286 | TX | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207L00000X | MD.021286 | LA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 009942927 | 05 | AL |   | MEDICAID | 1669563 | 05 | LA |   | MEDICAID | P00391824 | 01 | GA | RAILROAD MEDICARE | OTHER |