Provider Demographics
NPI:1497871164
Name:NORTHEAST LOUISIANA GYNECOLOGY CLINIC, APMC
Entity Type:Organization
Organization Name:NORTHEAST LOUISIANA GYNECOLOGY CLINIC, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SEVIER
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:318-281-8596
Mailing Address - Street 1:618 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-5035
Mailing Address - Country:US
Mailing Address - Phone:318-281-8596
Mailing Address - Fax:318-281-9015
Practice Address - Street 1:618 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5035
Practice Address - Country:US
Practice Address - Phone:318-281-8596
Practice Address - Fax:318-281-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012780207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DC15Medicare PIN