MEDICARE: PHILIP G. PADGETT, AMPC

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	207Q00000X	Family Medicine Physician	019597	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	930071021	OTHER	LA	RRR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700096690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP G. PADGETT, AMPC

Provider Business Mailing Address
First Line	:	610 N JEFFERSON AVE
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2414
Country	:	US
Telephone Number	:	225-267-6626
Fax Number	:	225-267-5993

Provider Business Practice Location Address
First Line	:	610 N JEFFERSON AVE
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2414
Country	:	US
Telephone Number	:	225-267-6626
Fax Number	:	225-267-5993

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHILIP G. PADGETT
Credential	:	M.D.
Telephone Number	:	225-267-6626

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	03/07/2023

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