MEDICARE: RALPH R NIX III 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	174400000X	Specialist	010588	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5B936	OTHER	LA	MEDICARE GROUP NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1518084698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALPH R NIX III LLC

Provider Business Mailing Address
First Line	:	PO BOX 9012
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70470-9012
Country	:	US
Telephone Number	:	985-626-8223
Fax Number	:	985-626-8253

Provider Business Practice Location Address
First Line	:	1580 W CAUSEWAY APPROACH
Second Line	:	SUITE 3
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3033
Country	:	US
Telephone Number	:	985-626-8223
Fax Number	:	985-626-8253

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RALPH R NIX
Credential	:	MD
Telephone Number	:	985-626-8223

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	01/28/2011

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