1376760728 NPI number — D & G HOLDINGS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376760728 NPI number — D & G HOLDINGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
D & G HOLDINGS, 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:
DRS LAB
Provider Other Organization Name Type Code:
3
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:
1376760728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7161
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71137-7161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-390-7611
Provider Business Mailing Address Fax Number:
318-949-5123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8516 STODDARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71065-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-796-3894
Provider Business Practice Location Address Fax Number:
318-796-2104
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
UNDERWOOD
Authorized Official First Name:
TRACIE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
318-390-7611

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1191132 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00063345 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: BLUE CROSS OF LA . This is a "PROVIDER ID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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