1235536723 NPI number — LMG, LLC

Table of content: (NPI 1235536723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235536723 NPI number — LMG, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LMG, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235536723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4633 WICHERS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARRERO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70072-3002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-391-7670
Provider Business Mailing Address Fax Number:
504-378-9439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4633 WICHERS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARRERO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70072-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-391-7670
Provider Business Practice Location Address Fax Number:
504-378-9439
Provider Enumeration Date:
11/26/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GALLAGHER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
504-391-7670

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7352890002 . This is a "DME PTAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".