Provider Demographics
NPI:1376840116
Name:ALBERT TYDINGS MD, APMC
Entity Type:Organization
Organization Name:ALBERT TYDINGS MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:IRVING
Authorized Official - Last Name:TYDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-892-1111
Mailing Address - Street 1:121 LAKEVIEW CIR STE C
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7513
Mailing Address - Country:US
Mailing Address - Phone:985-892-1111
Mailing Address - Fax:985-892-1116
Practice Address - Street 1:121 LAKEVIEW CIR STE C
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7513
Practice Address - Country:US
Practice Address - Phone:985-892-1111
Practice Address - Fax:985-892-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05024R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1300446Medicaid
LA2128906Medicaid
LA2128906Medicaid
LA1300446Medicaid