Provider Demographics
NPI:1265629166
Name:SEASONS HEALTHCARE OF MONROE, L.L.C.
Entity Type:Organization
Organization Name:SEASONS HEALTHCARE OF MONROE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GOODYEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-387-2828
Mailing Address - Street 1:1888 HUDSON CIRCLE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-387-2828
Mailing Address - Fax:318-387-2827
Practice Address - Street 1:1888 HUDSON CIRCLE
Practice Address - Street 2:SUITE 10
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-387-2828
Practice Address - Fax:318-387-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN075367163WG0000X
LARNO82557163WG0000X
LAMD.201086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295731818OtherNPI
LARN075367OtherRN LICENSE
LARNO82557OtherRN
LAAP04115OtherAPRN LICENSE
LA020455OtherPRESC ID
1538166970OtherNPI
1720054075OtherNPI
LAAPO4477OtherAP
LAMD. 201086OtherSTATE LICENSE
P79640Medicare UPIN
LARNO82557OtherRN
1720054075OtherNPI