Provider Demographics
NPI:1043329071
Name:DR. TINTIN DEVOE A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DR. TINTIN DEVOE A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:MANDEVILLE PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-845-8894
Mailing Address - Street 1:4880 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6748
Mailing Address - Country:US
Mailing Address - Phone:985-845-8894
Mailing Address - Fax:985-845-1969
Practice Address - Street 1:4880 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6748
Practice Address - Country:US
Practice Address - Phone:985-845-8894
Practice Address - Fax:985-845-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0169222080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0678432OtherAETNA
174540401769OtherHUMANA
4254173OtherAETNA
53252OtherBLUE CROSS / BLUE SHIELD
26652840AOtherBLUE CROSS FEDERAL
LA1447048Medicaid
1200111OtherUNITEDHEALTH CARE
LA1326551Medicaid
85720OtherCOVENTRY HEALTH