Provider Demographics
NPI:1780799957
Name:MAC VELINGKER MD
Entity type:Organization
Organization Name:MAC VELINGKER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANGUESH
Authorized Official - Middle Name:G
Authorized Official - Last Name:VELINGKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-392-0222
Mailing Address - Street 1:103 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4025
Mailing Address - Country:US
Mailing Address - Phone:337-392-0222
Mailing Address - Fax:337-392-0226
Practice Address - Street 1:103 N 5TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4025
Practice Address - Country:US
Practice Address - Phone:337-392-0222
Practice Address - Fax:337-392-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1436321Medicaid
LA1436321Medicaid