Provider Demographics
NPI:1013420264
Name:MEDICAL PROFESSIONAL CLINICAL SERVICES
Entity Type:Organization
Organization Name:MEDICAL PROFESSIONAL CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:DELAUGHTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:NP
Authorized Official - Phone:225-954-5596
Mailing Address - Street 1:8733 SIEGEN LN # 104
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1945
Mailing Address - Country:US
Mailing Address - Phone:225-954-5596
Mailing Address - Fax:
Practice Address - Street 1:59215 RIVER WEST DR
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6552
Practice Address - Country:US
Practice Address - Phone:225-954-5596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty