Provider Demographics
NPI:1275087033
Name:IMPACT NETWORK, LLC
Entity Type:Organization
Organization Name:IMPACT NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ZOHAIR
Authorized Official - Last Name:PIRZADAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-505-7104
Mailing Address - Street 1:11408 LAKE SHERWOOD AVE N
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-0406
Mailing Address - Country:US
Mailing Address - Phone:225-214-0077
Mailing Address - Fax:225-214-3423
Practice Address - Street 1:13636 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-5013
Practice Address - Country:US
Practice Address - Phone:225-505-7104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty