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General NPI Number Information
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NPI Number | 1700181997
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Entity Type | Organization
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Legal Business Name | HOLLAND J PITRE MD APMC
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 12 PROFESSIONAL DR
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City | HOUMA
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State | LA
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Zip | 70360-4046
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Country | US
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Telephone | 985-868-1810
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Fax | 985-876-3670
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Provider Business Mailing Address
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Address Line | 12 PROFESSIONAL DRIVE
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City | HOUMA
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State | LA
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Zip | 70360-4086
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Country | US
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Telephone | 985-868-1810
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Fax | 985-876-3670
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | MRS. TINA T LEVRON
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Credential |
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Telephone | 985-868-1810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 12026
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License Number State | LA
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