=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417078361
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | P & L MEDICAL SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 06/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1112 N CARROLLTON AVE
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70806-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-218-8998
-----------------------------------------------------
Fax | 225-218-8881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1112 N CARROLLTON AVE
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70806-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-218-8998
-----------------------------------------------------
Fax | 225-218-8881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JEFFERY N LACOUR SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-218-8998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | PCA10833
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | PCA11338
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 10833
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------