Provider Demographics
NPI:1669592218
Name:RIVER PARISHES PHYSICIAN PRACTICES LLC
Entity type:Organization
Organization Name:RIVER PARISHES PHYSICIAN PRACTICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:429 W AIRLINE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3817
Mailing Address - Country:US
Mailing Address - Phone:985-652-5052
Mailing Address - Fax:985-652-1912
Practice Address - Street 1:429 W AIRLINE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3817
Practice Address - Country:US
Practice Address - Phone:985-652-5052
Practice Address - Fax:985-652-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447447Medicaid
LA1447447Medicaid