New Haven MHT LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD.202004 Issued in LA

Legal business name

NEW HAVEN MHT LLC

Practice address

333 Doctor Michael Debakey Dr
Suite 120
Lake Charles, LA 70601-5887

Phone

(855) 860-2109

NPI assigned

Mar 14, 2014

Organization subpart

No

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

Authorized official

Name

Anthony Adeosun, M.D.

Title

Owner

Phone

(855) 860-2109

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406764800000",
    "number": "1356767305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 HERITAGE DRIVE",
            "address_2": "SUITE 110",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750693379",
            "telephone_number": "972-616-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 DOCTOR MICHAEL DEBAKEY DR",
            "address_2": "SUITE 120",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015887",
            "telephone_number": "855-860-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW HAVEN MHT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-14",
        "last_updated": "2014-07-31",
        "status": "A",
        "authorized_official_last_name": "ADEOSUN",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-860-2109",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.202004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; 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.