Provider Demographics
NPI:1497754030
Name:OPEN AIR OF MSLOU LLC
Entity Type:Organization
Organization Name:OPEN AIR OF MSLOU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-291-9161
Mailing Address - Street 1:54 SEARGENT PRENTISS DR S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-442-2585
Mailing Address - Fax:601-442-6299
Practice Address - Street 1:54 SEARGENT PRENTISS DR S
Practice Address - Street 2:SUITE 100
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-442-2585
Practice Address - Fax:601-442-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124853Medicaid
LA1442208Medicaid
MS00124853Medicaid
LA1442208Medicaid