Healthcare Provider Details

I. General information

NPI: 1033196597
Provider Name (Legal Business Name): KEVIN JOSEPH BISHOP IDHS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. COAST GUARD, 2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

PO BOX 7133
BELLE CHASSE LA
70037-7133
US

V. Phone/Fax

Practice location:
  • Phone: 504-556-8112
  • Fax: 504-556-8115
Mailing address:
  • Phone: 504-556-8112
  • Fax: 504-556-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: