Provider Demographics
NPI:1821333634
Name:PROFESSIONAL INTRATHECAL MANAGEMENT
Entity Type:Organization
Organization Name:PROFESSIONAL INTRATHECAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:FEUCHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-466-3497
Mailing Address - Street 1:227 FEUCHT LN
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:227 FEUCHT LN
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5134
Practice Address - Country:US
Practice Address - Phone:337-466-3497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion