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General NPI Number Information
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NPI Number | 1013087154
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Entity Type | Organization
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Legal Business Name | DOCTORS HEARING CENTER LLC LXXIV
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4414 JOHNSTON STREET SUITE D
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City | LAFAYETTE
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State | LA
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Zip | 70503
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Country | US
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Telephone | 337-989-4327
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Fax | 337-989-4609
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Provider Business Mailing Address
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Address Line | 2227 WEST MAIN STREET
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City | JACKSONVILLE
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State | AR
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Zip | 72076
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Country | US
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Telephone | 501-985-9944
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Fax | 501-985-6590
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Authorized Official
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Title or Position | PARTNER OFFICER
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Name | MR. RONALD F DAVIS
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Credential |
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Telephone | 501-985-9944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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