Provider Demographics
NPI:1013087154
Name:DOCTORS HEARING CENTER LLC LXXIV
Entity Type:Organization
Organization Name:DOCTORS HEARING CENTER LLC LXXIV
Other - Org Name:DOCTORS TESTING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-985-9944
Mailing Address - Street 1:2227 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076
Mailing Address - Country:US
Mailing Address - Phone:501-985-9944
Mailing Address - Fax:501-985-6590
Practice Address - Street 1:4414 JOHNSTON STREET
Practice Address - Street 2:SUITE D
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-989-4327
Practice Address - Fax:337-989-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LATBAMedicare ID - Type Unspecified