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General NPI Number Information
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NPI Number | 1184027195
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Entity Type | Organization
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Legal Business Name | LOUISIANA STATE PSYCHIATRY LLC
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Dates
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Enumeration Date | 10/04/2014
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Last Update Date | 10/04/2014
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Provider Practice Location Address
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Address Line | 6810 JEFFERSON HWY APT 1309
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City | BATON ROUGE
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State | LA
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Zip | 70806-8175
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Country | US
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Telephone | 225-366-7126
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Fax |
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Provider Business Mailing Address
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Address Line | 6810 JEFFERSON HWY APT 1309
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City | BATON ROUGE
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State | LA
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Zip | 70806-8175
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. TIMOTHY JEIDER
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Credential | M.D.
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Telephone | 225-366-7126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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