Provider Demographics
NPI:1255502282
Name:PDI OF THE SOUTH, INC.
Entity Type:Organization
Organization Name:PDI OF THE SOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/PAYROLL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-479-0048
Mailing Address - Street 1:710 W PRIEN LAKE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8349
Mailing Address - Country:US
Mailing Address - Phone:337-479-0048
Mailing Address - Fax:337-479-0685
Practice Address - Street 1:710 W PRIEN LAKE RD
Practice Address - Street 2:STE 100
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8349
Practice Address - Country:US
Practice Address - Phone:337-479-0048
Practice Address - Fax:337-479-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7131251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1455113Medicaid