Provider Demographics
NPI:1558662437
Name:HEALTHSMART HOUSE CALLS, LLC
Entity Type:Organization
Organization Name:HEALTHSMART HOUSE CALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEIDIGH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:337-905-6895
Mailing Address - Street 1:PO BOX 12590
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70612-2590
Mailing Address - Country:US
Mailing Address - Phone:337-905-6895
Mailing Address - Fax:337-905-6896
Practice Address - Street 1:711 IROQUOIAN DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-4940
Practice Address - Country:US
Practice Address - Phone:337-905-6895
Practice Address - Fax:337-905-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C709OtherMEDICARE
LA1167274Medicaid
LA1167274Medicaid