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General NPI Number Information
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NPI Number | 1124645130
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Entity Type | Organization
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Legal Business Name | BAYOU TELEMEDICINE LLC
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 1703 ARIZONA AVE
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City | MONROE
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State | LA
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Zip | 71202-3632
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Country | US
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Telephone | 800-819-3218
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Fax | 800-819-6261
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Provider Business Mailing Address
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Address Line | PO BOX 1221
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City | MANSFIELD
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State | TX
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Zip | 76063-1221
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Country | US
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Telephone | 800-819-3218
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Fax | 800-819-6261
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA JONES
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Credential |
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Telephone | 800-819-3218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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