Provider Demographics
NPI:1528398617
Name:BITARS SPECIALTY CLINIC, LLC
Entity Type:Organization
Organization Name:BITARS SPECIALTY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:NASIM
Authorized Official - Last Name:BITAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-774-9113
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-0608
Mailing Address - Country:US
Mailing Address - Phone:985-643-0075
Mailing Address - Fax:985-646-0430
Practice Address - Street 1:7020 HIGHWAY 190 STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-643-0075
Practice Address - Fax:985-646-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09189R207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1822523Medicaid
LA1822523Medicaid