Provider Demographics
NPI:1326236803
Name:NORTHSHORE RHEUMATOLOGY, L.L.C.
Entity Type:Organization
Organization Name:NORTHSHORE RHEUMATOLOGY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-871-9453
Mailing Address - Street 1:202 HIGHLAND PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7129
Mailing Address - Country:US
Mailing Address - Phone:985-871-9453
Mailing Address - Fax:985-871-9177
Practice Address - Street 1:202 HIGHLAND PARK PLZ
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7129
Practice Address - Country:US
Practice Address - Phone:985-871-9453
Practice Address - Fax:985-871-9177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHSHORE RHEUMATOLOGY, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13304R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1422207Medicaid
LA5CH62Medicare PIN
LA1422207Medicaid