=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457627085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUISIANA ON SITE FLU, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2012
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3220 N TURNBULL DR
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-5732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-456-8515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3220 N TURNBULL DR
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-5732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-456-8515
-----------------------------------------------------
Fax | 504-456-8516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. MICHELE EICHHORN
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 504-456-8515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------