Provider Demographics
NPI:1770872418
Name:PHILLIP A BARKSDALE APMC
Entity type:Organization
Organization Name:PHILLIP A BARKSDALE APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BARKSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-928-9881
Mailing Address - Street 1:9000 AIRLINE HWY
Mailing Address - Street 2:SUITE 650
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4114
Mailing Address - Country:US
Mailing Address - Phone:225-928-9881
Mailing Address - Fax:225-928-5770
Practice Address - Street 1:9000 AIRLINE HWY
Practice Address - Street 2:SUITE 650
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4114
Practice Address - Country:US
Practice Address - Phone:225-928-9881
Practice Address - Fax:225-928-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09178R207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1981109Medicaid
LA1981109Medicaid