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NPI Code Detail

MEDICARE: MR. PAXTON E. OLIVER II M.S.

MEDICARE: MR. PAXTON E. OLIVER II M.S.
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1952634222
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAXTON E. OLIVER II M.S.
Provider Business Mailing Address
First Line : 2006 GUS KAPLAN DR
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-3376
Country : US
Telephone Number : 318-487-5395
Fax Number : 318-487-5463
Provider Business Practice Location Address
First Line : 2006 GUS KAPLAN DR
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-3376
Country : US
Telephone Number : 318-487-5395
Fax Number : 318-487-5463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2009
Last Update Date : 09/17/2009

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