Provider Demographics
NPI:1144407677
Name:BLACKWELL SOLUTIONS PCA
Entity Type:Organization
Organization Name:BLACKWELL SOLUTIONS PCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-3099
Mailing Address - Street 1:8841 BLUEBONNET BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2847
Mailing Address - Country:US
Mailing Address - Phone:225-767-3099
Mailing Address - Fax:
Practice Address - Street 1:8841 BLUEBONNET BLVD
Practice Address - Street 2:STE E
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2847
Practice Address - Country:US
Practice Address - Phone:225-767-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 14074302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1409065Medicaid
LA5887410001Medicare NSC