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General NPI Number Information
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NPI Number | 1821458134
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Entity Type | Organization
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Legal Business Name | JAMES C BUTLER
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 1150 ROBERT BLVD SUITE 240
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City | SLIDELL
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State | LA
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Zip | 70458-2005
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Country | US
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Telephone | 985-646-3662
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Fax | 985-641-9281
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Provider Business Mailing Address
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Address Line | 1150 ROBERT BLVD SUITE 240
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City | SLIDELL
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State | LA
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Zip | 70458-2004
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Country | US
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Telephone | 985-646-3662
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Fax | 985-641-9281
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Authorized Official
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Title or Position | ASSISTANT
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Name | KIM R TANNER
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Credential | LSRT
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Telephone | 985-646-3662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 014621
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License Number State | LA
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