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General NPI Number Information
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NPI Number | 1558662437
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Entity Type | Organization
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Legal Business Name | HEALTHSMART HOUSE CALLS, LLC
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 711 IROQUOIAN DR
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City | LAKE CHARLES
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State | LA
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Zip | 70611-4940
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Country | US
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Telephone | 337-905-6895
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Fax | 337-905-6896
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Provider Business Mailing Address
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Address Line | PO BOX 12590
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City | LAKE CHARLES
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State | LA
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Zip | 70612-2590
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Country | US
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Telephone | 337-905-6895
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Fax | 337-905-6896
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Authorized Official
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Title or Position | OWNER
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Name | MR. TIMOTHY S NEIDIGH
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Credential | FNP-BC
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Telephone | 337-905-6895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP04229
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License Number State | LA
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