Provider Demographics
NPI:1508910969
Name:CHARLES J. MONIER, JR., MD, LLC
Entity Type:Organization
Organization Name:CHARLES J. MONIER, JR., MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PONVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-446-1200
Mailing Address - Street 1:PO BOX 1178
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-1178
Mailing Address - Country:US
Mailing Address - Phone:800-639-2519
Mailing Address - Fax:
Practice Address - Street 1:602 N ACADIA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-446-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2900051OtherUNITED HEALTHCARE
LA4552584OtherAETNA
LADD942OtherRAILROAD MEDICARE
LA2900051OtherUNITED HEALTHCARE