Basic Information
| Provider Information | |||||||||
| NPI: | 1821034620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HOSPITALIST PRACTICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 WALL BLVD | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700567107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043932775 | ||||||||
| FaxNumber: | 5043932744 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 WALL BLVD | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700567107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043932775 | ||||||||
| FaxNumber: | 5043932744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| AuthorizedOfficialLastName: | GUILLEN | ||||||||
| AuthorizedOfficialFirstName: | JULIO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5043932775 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1445428 | 05 | LA | MEDICAID |