Provider Demographics
NPI:1891846861
Name:MEDICAL SPECIALISTS OF NEW ORLEANS, INC
Entity Type:Organization
Organization Name:MEDICAL SPECIALISTS OF NEW ORLEANS, INC
Other - Org Name:MEDICAL SPECIALISTS OF NEW ORLEANS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGLIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:504-897-4017
Mailing Address - Street 1:3525 PRYTANIA ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3500
Mailing Address - Country:US
Mailing Address - Phone:504-897-4017
Mailing Address - Fax:504-899-6775
Practice Address - Street 1:1206 J W DAVIS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5953
Practice Address - Country:US
Practice Address - Phone:504-897-4017
Practice Address - Fax:504-899-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA075450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444171Medicaid
LA1444171Medicaid