NPIMap

Organization Active NPI

Libby Ellent MD Internal Medicine Clinic

  • Internal Medicine Physician
  • Marrero, LA
National Provider Identifier
1356512107
Registry record updated Oct 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
12226R Issued in LA
Legal business name
LIBBY ELLENT MD INTERNAL MEDICINE CLINIC
Practice address
1111 Medical Center Blvd
Suite N308
Marrero, LA 70072-3151
Phone
(504) 349-6390
Fax
(504) 349-6391
NPI assigned
Mar 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Ellent
Title
Office Manager
Phone
(504) 349-6390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 12226R LA Primary

Addresses

Primary practice location

1111 Medical Center Blvd
Suite N308
Marrero, LA 70072-3151

Mailing address

1111 Medical Center Blvd
Suite N308
Marrero, LA 70072-3151
Phone (504) 349-6390

National Provider Directory

National Provider Directory

Locations

1111 Medical Center Blvd
Ste N308
Marrero, LA 70072
Phone (504) 349-6390

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255564800000",
    "number": "1356512107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "SUITE N308",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-349-6390",
            "fax_number": "504-349-6391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "SUITE N308",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-349-6390",
            "fax_number": "504-349-6391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBBY ELLENT MD INTERNAL MEDICINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-20",
        "last_updated": "2009-10-15",
        "status": "A",
        "authorized_official_last_name": "ELLENT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "504-349-6390"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "12226R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marrero, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.