Provider Demographics
NPI:1649430331
Name:TORMA EXECUTIVES CONSULTANTS LLC
Entity type:Organization
Organization Name:TORMA EXECUTIVES CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TORMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-212-5911
Mailing Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 138
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3132
Mailing Address - Country:US
Mailing Address - Phone:318-212-5911
Mailing Address - Fax:318-212-5931
Practice Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 138
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3132
Practice Address - Country:US
Practice Address - Phone:318-212-5911
Practice Address - Fax:318-212-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12523R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1159999Medicaid
LA4F718Medicare PIN
LAF50739Medicare UPIN