Provider Demographics
NPI:1164620357
Name:DAVID M. REMEDIOS APMC
Entity Type:Organization
Organization Name:DAVID M. REMEDIOS APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:REMEDIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-442-6989
Mailing Address - Street 1:5615 JACKSON STREET EXT
Mailing Address - Street 2:BUILDING E.
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2326
Mailing Address - Country:US
Mailing Address - Phone:318-442-6989
Mailing Address - Fax:318-442-7123
Practice Address - Street 1:5615 JACKSON STREET EXT
Practice Address - Street 2:BUILDING E.
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2326
Practice Address - Country:US
Practice Address - Phone:318-442-6989
Practice Address - Fax:318-442-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CJ44Medicare PIN