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NPI Code Detail

MEDICARE: EBONY M BRANCH

MEDICARE: EBONY M BRANCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1144689787
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY M BRANCH
Provider Business Mailing Address
First Line : 3973 CHOCTAW DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-6722
Country : US
Telephone Number : 225-361-0507
Fax Number :
Provider Business Practice Location Address
First Line : 3973 CHOCTAW DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-6722
Country : US
Telephone Number : 225-361-0507
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2016
Last Update Date : 02/10/2016

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Directions to “ EBONY M BRANCH ” Practice Location

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