Provider Demographics
NPI:1306867429
Name:ASHLAR MEDICAL, LLC
Entity Type:Organization
Organization Name:ASHLAR MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-785-8766
Mailing Address - Street 1:816 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457
Mailing Address - Country:US
Mailing Address - Phone:318-352-8075
Mailing Address - Fax:318-357-1535
Practice Address - Street 1:1908 GREENWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2430
Practice Address - Country:US
Practice Address - Phone:573-785-8766
Practice Address - Fax:573-785-8769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHLAR MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000091607Medicare ID - Type UnspecifiedUROLOGY