Provider Demographics
NPI:1649317587
Name:HAYDEL FAMILY PRACTICE, APMC
Entity type:Organization
Organization Name:HAYDEL FAMILY PRACTICE, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HAYDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-876-2150
Mailing Address - Street 1:502 BARROW ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4606
Mailing Address - Country:US
Mailing Address - Phone:985-876-2150
Mailing Address - Fax:985-876-7413
Practice Address - Street 1:502 BARROW ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4606
Practice Address - Country:US
Practice Address - Phone:985-876-2150
Practice Address - Fax:985-876-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1127450001Medicare NSC
LA5F792Medicare ID - Type Unspecified