1295728020 NPI number — JOB LAMBETH HAMMOND IV CRNA

Table of content: JOB LAMBETH HAMMOND IV CRNA (NPI 1295728020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295728020 NPI number — JOB LAMBETH HAMMOND IV CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMOND
Provider First Name:
JOB
Provider Middle Name:
LAMBETH
Provider Name Prefix Text:
Provider Name Suffix Text:
IV
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1295728020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 4TH ST
Provider Second Line Business Mailing Address:
BOX 30135
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71301-8421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-448-4440
Provider Business Mailing Address Fax Number:
318-473-4340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-8421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-448-4440
Provider Business Practice Location Address Fax Number:
318-473-4340
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN102466 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 7035 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 430074757 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1124079 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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