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NPI Code Detail

MEDICARE: EARL K LONG MEDICAL CENTER

MEDICARE: EARL K LONG MEDICAL CENTER
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
13336C0002XClinic Pharmacy
23336I0012XInstitutional PharmacyPHY.004380-IRXLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21914820OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1548271653
Entity Type Code : Organization
Provider Name (Legal Business Name) : EARL K LONG MEDICAL CENTER
Provider Business Mailing Address
First Line : EKLMC-OUT PHARMACY
Second Line : 5825 AIRLINE HWY
City : BATON ROUGE
State : LA
Zip : 70805
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5825 AIRLINE HWY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-2408
Country : US
Telephone Number : 225-358-4826
Fax Number : 225-358-4827
Authorized Official
Title or Position : PHARMACY DIRECTOR
Name : NIKKI LEE
Credential :
Telephone Number : 225-358-4826
Provider Enumeration Date : 08/11/2006
Last Update Date : 02/13/2013

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Directions to “EARL K LONG MEDICAL CENTER ” Practice Location

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