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General NPI Number Information
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NPI Number | 1831597137
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Entity Type | Organization
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Legal Business Name | ADVANCED THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 1799 STUMPF BLVD BLDG 3
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City | TERRYTOWN
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State | LA
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Zip | 70056-3950
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Country | US
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Telephone | 504-407-0755
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Fax | 504-407-0778
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Provider Business Mailing Address
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Address Line | 1799 STUMPF BLVD BLDG 3
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City | TERRYTOWN
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State | LA
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Zip | 70056-3950
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Country | US
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Telephone | 504-407-0755
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Fax | 504-407-0778
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Authorized Official
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Title or Position | OWNER
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Name | MR. RUDOLPH CASANOVA CLARKE
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Credential |
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Telephone | 504-621-2306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 305R00000X
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License Number State | LA
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