Provider Demographics
NPI:1073232849
Name:MEDICAL MALL HEALTH SERVICES OF LOUISIANA
Entity Type:Organization
Organization Name:MEDICAL MALL HEALTH SERVICES OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-806-6923
Mailing Address - Street 1:3745 CHOCTAW DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-8333
Mailing Address - Country:US
Mailing Address - Phone:225-806-6923
Mailing Address - Fax:225-372-8105
Practice Address - Street 1:3745 CHOCTAW DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-8333
Practice Address - Country:US
Practice Address - Phone:225-806-6923
Practice Address - Fax:225-372-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No347C00000XTransportation ServicesPrivate Vehicle