Provider Demographics
NPI:1700096690
Name:PHILIP G. PADGETT, AMPC
Entity Type:Organization
Organization Name:PHILIP G. PADGETT, AMPC
Other - Org Name:WBR FAMILY AND OCCUPATIONAL MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-267-6626
Mailing Address - Street 1:610 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2414
Mailing Address - Country:US
Mailing Address - Phone:225-267-6626
Mailing Address - Fax:225-267-5993
Practice Address - Street 1:610 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2414
Practice Address - Country:US
Practice Address - Phone:225-267-6626
Practice Address - Fax:225-267-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA930071021OtherRRR
LA1378437Medicaid
LA1378437Medicaid
LA930071021OtherRRR