Provider Demographics
NPI:1336481449
Name:PRIDE GAZ INC
Entity Type:Organization
Organization Name:PRIDE GAZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:OGBOMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-905-4445
Mailing Address - Street 1:308 STONEBRIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5364
Mailing Address - Country:US
Mailing Address - Phone:504-905-4445
Mailing Address - Fax:
Practice Address - Street 1:308 STONEBRIDGE LOOP
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5364
Practice Address - Country:US
Practice Address - Phone:504-905-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty