Provider Demographics
NPI:1982850178
Name:T L HAUTH A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:T L HAUTH A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-781-0548
Mailing Address - Street 1:959 TOPAZ ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3627
Mailing Address - Country:US
Mailing Address - Phone:985-781-0548
Mailing Address - Fax:985-781-4319
Practice Address - Street 1:1525 RIVER OAKS RD W
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-2162
Practice Address - Country:US
Practice Address - Phone:504-734-1740
Practice Address - Fax:504-733-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10019R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5E401OtherMEDICARE