Provider Demographics
NPI:1063629772
Name:TRI-PARISH ORTHOPEDIC & NEUROSURGICAL INSTITUTE,LLC
Entity Type:Organization
Organization Name:TRI-PARISH ORTHOPEDIC & NEUROSURGICAL INSTITUTE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:V
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-873-1477
Mailing Address - Street 1:115 EUREKA DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-3247
Mailing Address - Country:US
Mailing Address - Phone:985-873-1477
Mailing Address - Fax:985-873-1545
Practice Address - Street 1:115 EUREKA DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-3247
Practice Address - Country:US
Practice Address - Phone:985-873-1477
Practice Address - Fax:985-873-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD15687R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1012432Medicaid
LA1012432Medicaid
LAF83232Medicare UPIN
LA5906860001Medicare NSC