Provider Demographics
NPI:1659614865
Name:EXTREMITY CMA, LLC
Entity Type:Organization
Organization Name:EXTREMITY CMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHENILE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEZENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-1237
Mailing Address - Street 1:2878 TATE COVE RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-6311
Mailing Address - Country:US
Mailing Address - Phone:337-363-1237
Mailing Address - Fax:337-363-1384
Practice Address - Street 1:2878 TATE COVE RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-6311
Practice Address - Country:US
Practice Address - Phone:337-363-1237
Practice Address - Fax:337-363-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM 27068302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization