Provider Demographics
NPI:1851347579
Name:LYDIA F SIMS MD LLC
Entity Type:Organization
Organization Name:LYDIA F SIMS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-763-4237
Mailing Address - Street 1:8595 PICARDY AVE
Mailing Address - Street 2:STE. 310
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3670
Mailing Address - Country:US
Mailing Address - Phone:225-763-4237
Mailing Address - Fax:225-763-4238
Practice Address - Street 1:8595 PICARDY AVE
Practice Address - Street 2:STE. 310
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3670
Practice Address - Country:US
Practice Address - Phone:225-763-4237
Practice Address - Fax:225-763-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12550R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DF49Medicare PIN
LA19D0462660Medicare ID - Type UnspecifiedCLIA NUMBER