Provider Demographics
NPI:1508829599
Name:ELIZABETH CLUBB, APMC
Entity Type:Organization
Organization Name:ELIZABETH CLUBB, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLUBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-766-7771
Mailing Address - Street 1:4864 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9644
Mailing Address - Country:US
Mailing Address - Phone:225-766-7771
Mailing Address - Fax:225-766-7995
Practice Address - Street 1:BLUEBONNET BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70836-1206
Practice Address - Country:US
Practice Address - Phone:225-766-7771
Practice Address - Fax:225-766-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11291R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1664278Medicaid
LA1664278Medicaid
LA5W242Medicare PIN