Provider Demographics
NPI:1356476956
Name:DEAN MEDICAL CARE, L.L.C.
Entity Type:Organization
Organization Name:DEAN MEDICAL CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-687-9700
Mailing Address - Street 1:59325 RIVER WEST DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-6553
Mailing Address - Country:US
Mailing Address - Phone:225-687-9700
Mailing Address - Fax:225-687-2999
Practice Address - Street 1:59325 RIVER WEST DR.
Practice Address - Street 2:SUITE B
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6553
Practice Address - Country:US
Practice Address - Phone:225-687-9700
Practice Address - Fax:225-687-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200513207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1052485Medicaid
LAI45430Medicare UPIN
LA4J967CS41Medicare ID - Type Unspecified