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NPI Code Detail

MEDICARE: DR. EDNA WISE MCLEOD MD

MEDICARE: DR. EDNA WISE MCLEOD MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician009944LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093713810
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDNA WISE MCLEOD MD
Provider Business Mailing Address
First Line : PO BOX 207
Second Line :
City : NATCHITOCHES
State : LA
Zip : 71458-0207
Country : US
Telephone Number : 318-352-3492
Fax Number : 318-352-3524
Provider Business Practice Location Address
First Line : 501 KEYSER AVE
Second Line :
City : NATCHITOCHES
State : LA
Zip : 71457-6018
Country : US
Telephone Number : 318-214-4274
Fax Number : 318-214-4275
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 09/15/2008

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