Provider Demographics
NPI:1154319762
Name:RENAL ASSOCIATES OF NORTHEAST LOUISIANA APMC
Entity Type:Organization
Organization Name:RENAL ASSOCIATES OF NORTHEAST LOUISIANA APMC
Other - Org Name:RENAL ASSOCIATES OF NORTHEAST LOUISIANA, APMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-325-5435
Mailing Address - Street 1:401 THOMAS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-7903
Mailing Address - Country:US
Mailing Address - Phone:318-325-5435
Mailing Address - Fax:318-325-5495
Practice Address - Street 1:401 THOMAS RD STE 1
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-7903
Practice Address - Country:US
Practice Address - Phone:318-325-5435
Practice Address - Fax:318-325-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1947997Medicaid
H25015OtherVANTAGE
LA1947997Medicaid
5F959Medicare ID - Type Unspecified