Provider Demographics
NPI:1881880763
Name:PMA MEDICAL TREATMENT CENTERS, LLC
Entity type:Organization
Organization Name:PMA MEDICAL TREATMENT CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-782-8267
Mailing Address - Street 1:613 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-7635
Mailing Address - Country:US
Mailing Address - Phone:504-441-5555
Mailing Address - Fax:504-441-5550
Practice Address - Street 1:613 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7635
Practice Address - Country:US
Practice Address - Phone:504-441-5555
Practice Address - Fax:504-455-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty