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NPI Code Detail

MEDICARE: NICHOLAS LANDRY D.O. INC.

MEDICARE: NICHOLAS LANDRY D.O. INC.
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2$$$$$$$$$OTHERWVSOCIAL SECURITY NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000000303053OTHEROHANTHEM

General Provider Information

NPI Number : 1508967910
Entity Type Code : Organization
Provider Name (Legal Business Name) : NICHOLAS LANDRY D.O. INC.
Provider Business Mailing Address
First Line : 1325 NORTHUP RD
Second Line :
City : GALLIPOLIS
State : OH
Zip : 45631-8830
Country : US
Telephone Number : 740-441-9800
Fax Number : 740-441-9400
Provider Business Practice Location Address
First Line : 1354 JACKSON PIKE
Second Line :
City : GALLIPOLIS
State : OH
Zip : 45631-2601
Country : US
Telephone Number : 740-441-9800
Fax Number : 740-441-9400
Authorized Official
Title or Position : CEO
Name : DR. NICHOLAS V LANDRY
Credential : D.O.
Telephone Number : 740-441-9800
Provider Enumeration Date : 09/26/2006
Last Update Date : 05/21/2020

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Practice Location Address:
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Directions to “NICHOLAS LANDRY D.O. INC. ” Practice Location

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