Healthcare Provider Details

I. General information

NPI: 1831453422
Provider Name (Legal Business Name): MEDIPOINT STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LAFAYETTE ST SUITE 107
GRETNA LA
70053-5732
US

IV. Provider business mailing address

1500 LAFAYETTE ST SUITE 107
GRETNA LA
70053-5732
US

V. Phone/Fax

Practice location:
  • Phone: 504-615-5981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD204319
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License NumberMD204319
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberMD204319
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD204319
License Number StateLA

VIII. Authorized Official

Name: DR. RONALD MCLENDON JR.
Title or Position: CEO
Credential: M.D.
Phone: 504-615-5981