Provider Demographics
NPI:1003008509
Name:TED P. KEMP, M.D., L.L.C.
Entity type:Organization
Organization Name:TED P. KEMP, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:P
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-667-5110
Mailing Address - Street 1:315 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4722
Mailing Address - Country:US
Mailing Address - Phone:225-667-5110
Mailing Address - Fax:225-667-9303
Practice Address - Street 1:315 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4722
Practice Address - Country:US
Practice Address - Phone:225-667-5110
Practice Address - Fax:225-667-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.018237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CJ60Medicare PIN
LAB65249Medicare UPIN