MEDICARE: OPEN AIR OF MSLOU LLC

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
1	293D00000X	Physiological Laboratory

Other Identifiers

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

General Provider Information

NPI Number	:	1497754030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN AIR OF MSLOU LLC

Provider Business Mailing Address
First Line	:	54 SEARGENT PRENTISS DR S
Second Line	:	SUITE 100
City	:	NATCHEZ
State	:	MS
Zip	:	39120
Country	:	US
Telephone Number	:	601-442-2585
Fax Number	:	601-442-6299

Provider Business Practice Location Address
First Line	:	54 SEARGENT PRENTISS DR S
Second Line	:	SUITE 100
City	:	NATCHEZ
State	:	MS
Zip	:	39120
Country	:	US
Telephone Number	:	601-442-2585
Fax Number	:	601-442-6299

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	PATRICK G HOWARD
Credential	:
Telephone Number	:	337-291-9161

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	02/13/2015

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Directions to “OPEN AIR OF MSLOU LLC ” Practice Location

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