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General NPI Number Information
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NPI Number | 1700096690
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Entity Type | Organization
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Legal Business Name | PHILIP G. PADGETT, AMPC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 610 N JEFFERSON AVE
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City | PORT ALLEN
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State | LA
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Zip | 70767-2414
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Country | US
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Telephone | 225-267-6626
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Fax | 225-267-5993
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Provider Business Mailing Address
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Address Line | 610 N JEFFERSON AVE
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City | PORT ALLEN
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State | LA
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Zip | 70767-2414
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Country | US
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Telephone | 225-267-6626
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Fax | 225-267-5993
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP G. PADGETT
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Credential | M.D.
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Telephone | 225-267-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 019597
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License Number State | LA
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