Healthcare Provider Details

I. General information

NPI: 1831598861
Provider Name (Legal Business Name): M.D.PHYSICIAN BILLING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 WALL BLVD 1703
GRETNA LA
70056-8631
US

IV. Provider business mailing address

3251 WALL BLVD 1703
GRETNA LA
70056-8631
US

V. Phone/Fax

Practice location:
  • Phone: 504-300-7277
  • Fax:
Mailing address:
  • Phone: 504-300-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEMETRA BURKHALTER
Title or Position: CEO
Credential:
Phone: 972-505-6087