MEDICARE: AMEDISYS NORTHWEST, L.L.C.

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	251E00000X	Home Health Agency	112-095	GA

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	11Q7064002	OTHER	GA	BRANCH ID

General Provider Information

NPI Number	:	1982822623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMEDISYS NORTHWEST, L.L.C.

Provider Business Mailing Address
First Line	:	3854 AMERICAN WAY
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4013
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	111 MOUNTAIN VISTA BLVD
Second Line	:	SUITE 145
City	:	CANTON
State	:	GA
Zip	:	30115-4272
Country	:	US
Telephone Number	:	770-345-3630
Fax Number	:	770-345-3655

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL B KUSSEROW
Credential	:
Telephone Number	:	225-292-2031

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	09/28/2016

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