Provider Demographics
NPI:1508963968
Name:DYESS MEDICAL CENTER INCORPORATED
Entity Type:Organization
Organization Name:DYESS MEDICAL CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:DYESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-368-3100
Mailing Address - Street 1:100 MERGANSER DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6607
Mailing Address - Country:US
Mailing Address - Phone:985-951-8941
Mailing Address - Fax:985-951-8943
Practice Address - Street 1:# 12 WESTSIDE EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053
Practice Address - Country:US
Practice Address - Phone:504-368-3100
Practice Address - Fax:504-368-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4A028Medicare ID - Type Unspecified
LA5DH35Medicare PIN
LAH32062Medicare UPIN