Provider Demographics
NPI:1184708661
Name:HAYDEL ASTHMA & ALLERGY CLINIC
Entity type:Organization
Organization Name:HAYDEL ASTHMA & ALLERGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HAYDEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:985-868-7566
Mailing Address - Street 1:869 VERRET ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4635
Mailing Address - Country:US
Mailing Address - Phone:985-868-7566
Mailing Address - Fax:985-851-4778
Practice Address - Street 1:869 VERRET ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4635
Practice Address - Country:US
Practice Address - Phone:985-868-7566
Practice Address - Fax:985-851-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019894261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1966444Medicaid
LA5D288Medicare PIN
LAF62364Medicare UPIN