Healthcare Provider Details

I. General information

NPI: 1720650260
Provider Name (Legal Business Name): MICHEAL JAMAR PIPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 BENJAMIN ST
ALEXANDRIA LA
71303-4001
US

IV. Provider business mailing address

5010 BENJAMIN ST
ALEXANDRIA LA
71303-4001
US

V. Phone/Fax

Practice location:
  • Phone: 318-623-6201
  • Fax:
Mailing address:
  • Phone: 318-623-6201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: