Provider Demographics
NPI:1043477375
Name:DOCTORS FLYNN MANCEAUX ARCEMENT PIZZOLATO OF THIBODAUX A PROFESSIONAL
Entity type:Organization
Organization Name:DOCTORS FLYNN MANCEAUX ARCEMENT PIZZOLATO OF THIBODAUX A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVONNE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-868-3136
Mailing Address - Street 1:970 S ACADIA RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4978
Mailing Address - Country:US
Mailing Address - Phone:985-446-2403
Mailing Address - Fax:985-446-9954
Practice Address - Street 1:970 S ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4978
Practice Address - Country:US
Practice Address - Phone:985-446-2403
Practice Address - Fax:985-446-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1348111N00000X
LA1062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X276Medicare PIN
LAV04083Medicare UPIN
LA4H353Medicare PIN
LAU66065Medicare UPIN