Healthcare Provider Details

I. General information

NPI: 1669592218
Provider Name (Legal Business Name): RIVER PARISHES PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 W AIRLINE HWY SUITE B
LA PLACE LA
70068-3817
US

IV. Provider business mailing address

429 W AIRLINE HWY SUITE B
LA PLACE LA
70068-3817
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-5052
  • Fax: 985-652-1912
Mailing address:
  • Phone: 985-652-5052
  • Fax: 985-652-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JESS JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7000