Provider Demographics
NPI:1942585591
Name:IPH, SLIDEL LLC
Entity Type:Organization
Organization Name:IPH, SLIDEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-641-2202
Mailing Address - Street 1:501 MARSHALL ST
Mailing Address - Street 2:SUITE 607B
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1651
Mailing Address - Country:US
Mailing Address - Phone:601-948-6540
Mailing Address - Fax:601-948-6544
Practice Address - Street 1:2364 GAUSE BLVD E STE 101
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4141
Practice Address - Country:US
Practice Address - Phone:985-641-2202
Practice Address - Fax:985-641-2888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IPH HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-14
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty