Healthcare Provider Details

I. General information

NPI: 1144561085
Provider Name (Legal Business Name): M.D. PHYSICIAN BILLING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 WALL BLVD APT 1807
GRETNA LA
70056-8654
US

IV. Provider business mailing address

3251 WALL BLVD APT 1807
GRETNA LA
70056-8654
US

V. Phone/Fax

Practice location:
  • Phone: 504-265-7671
  • Fax:
Mailing address:
  • Phone: 504-265-7671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DEMETRA H BURKHALTER
Title or Position: CEO
Credential:
Phone: 504-265-7671