1922543107 NPI number — SOUTHERN COMMUNITY NETWORK

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 1922543107 NPI number — SOUTHERN COMMUNITY NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN COMMUNITY NETWORK
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:
1922543107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2714 CANAL ST
Provider Second Line Business Mailing Address:
SUITE 316
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70119-5548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-913-9335
Provider Business Mailing Address Fax Number:
985-785-7728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2714 CANAL ST
Provider Second Line Business Practice Location Address:
SUITE 316
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70119-5548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-913-9335
Provider Business Practice Location Address Fax Number:
985-785-7728
Provider Enumeration Date:
12/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
NAAMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
504-913-0901

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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