Provider Demographics
NPI:1720419450
Name:NICHOLS MED EVAL, LLC
Entity Type:Organization
Organization Name:NICHOLS MED EVAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:318-617-6662
Mailing Address - Street 1:PO BOX 5313
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-5313
Mailing Address - Country:US
Mailing Address - Phone:318-798-4664
Mailing Address - Fax:318-798-4457
Practice Address - Street 1:136 RIALS DR
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-8109
Practice Address - Country:US
Practice Address - Phone:318-575-9911
Practice Address - Fax:318-703-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty