NPIMap

Organization Active NPI

1St a Southeast Incs, LLC

  • Point of Service
  • Houma, LA
National Provider Identifier
1407074164
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
12649 Issued in LA
Legal business name
1ST A SOUTHEAST INCS, LLC
Practice address
614 Roussell St
Houma, LA 70360-4556
Phone
(985) 876-0559
NPI assigned
Apr 20, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Suzanne Dickerson
Title
Program Coordinator
Phone
(985) 876-0559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X 12649 LA Primary

Addresses

Primary practice location

614 Roussell St
Houma, LA 70360-4556

Mailing address

614 Roussell St
Houma, LA 70360-4556
Phone (985) 876-0559

Other identifiers 1

IdentifierTypeStateIssuer
1169145MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
1St a Southeast Incs LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407074164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 ROUSSELL ST",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703604556",
            "telephone_number": "985-876-0559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 ROUSSELL ST",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703604556",
            "telephone_number": "985-876-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST A SOUTHEAST INCS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "PROGRAM COORDINATOR",
        "authorized_official_telephone_number": "985-876-0559",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "LA",
            "license": "12649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1169145",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houma, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.