Provider Demographics
NPI: | 1659930931 |
---|---|
Name: | BIG EASY ACUPUNCTURE & HERBAL MEDICINE |
Entity Type: | Organization |
Organization Name: | BIG EASY ACUPUNCTURE & HERBAL MEDICINE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ACUPUNCTURTIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | GLENN |
Authorized Official - Middle Name: | MICHAEL |
Authorized Official - Last Name: | BRAUD |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | LAC |
Authorized Official - Phone: | 504-650-0027 |
Mailing Address - Street 1: | 3913 N I 10 SERVICE RD W APT 201 |
Mailing Address - Street 2: | |
Mailing Address - City: | METAIRIE |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70002-6854 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 504-650-0027 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4300 S I 10 SERVICE RD W STE 208 |
Practice Address - Street 2: | |
Practice Address - City: | METAIRIE |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70001-7431 |
Practice Address - Country: | US |
Practice Address - Phone: | 504-650-0027 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-06-10 |
Last Update Date: | 2020-12-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No | 251E00000X | Agencies | Home Health |