Provider Demographics
NPI:1013972843
Name:NORTHSHORE OB-GYN, APMC
Entity Type:Organization
Organization Name:NORTHSHORE OB-GYN, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-845-3564
Mailing Address - Street 1:393 HIGHWAY 21
Mailing Address - Street 2:SUITE 500-A
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3407
Mailing Address - Country:US
Mailing Address - Phone:985-845-3564
Mailing Address - Fax:985-845-3705
Practice Address - Street 1:393 HIGHWAY 21
Practice Address - Street 2:SUITE 500-A
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3407
Practice Address - Country:US
Practice Address - Phone:985-845-3564
Practice Address - Fax:985-845-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07195R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1941077Medicaid