Provider Demographics
NPI:1073774030
Name:ALEXANDRIA RHEUMATOLOGY, LLC
Entity Type:Organization
Organization Name:ALEXANDRIA RHEUMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:IZZAT
Authorized Official - Last Name:SHBEEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-767-8393
Mailing Address - Street 1:3311 PRESCOTT RD STE 211
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3983
Mailing Address - Country:US
Mailing Address - Phone:318-767-8393
Mailing Address - Fax:318-767-8399
Practice Address - Street 1:3311 PRESCOTT RD STE 211
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3983
Practice Address - Country:US
Practice Address - Phone:318-767-8393
Practice Address - Fax:318-767-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11711R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1690317Medicaid
LAF67371Medicare UPIN