St. Marygrace Family Practice, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

202981 Issued in LA

Legal business name

ST. MARYGRACE FAMILY PRACTICE, LLC

Practice address

1270 Attakapas Dr
Suite 404
Opelousas, LA 70570-6549

Phone

(337) 678-0918

Fax

(337) 678-0927

NPI assigned

Aug 23, 2009

Last updated

Mar 18, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Adenike A Tinubu, MDNPI 1306055652

Title

Owner / Operator / Physician

Phone

(337) 678-0918

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adenike Abimbola Tinubu, M.D.

  • Family Medicine Physician
  • Opelousas, LA
  • NPI 1306055652
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1250985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300406400000",
    "number": "1639301732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 ATTAKAPAS DR",
            "address_2": "SUITE 404",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705706549",
            "telephone_number": "337-678-0918",
            "fax_number": "337-678-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 ATTAKAPAS DR",
            "address_2": "SUITE 404",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705706549",
            "telephone_number": "337-678-0918",
            "fax_number": "337-678-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARYGRACE FAMILY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-23",
        "last_updated": "2011-03-18",
        "status": "A",
        "authorized_official_last_name": "TINUBU",
        "authorized_official_first_name": "ADENIKE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER / OPERATOR / PHYSICIAN",
        "authorized_official_telephone_number": "337-678-0918",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "202981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR'S NPI",
            "identifier": "1306055652",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4507245",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St. Landry Parish Community Action Agency
• St. Landry Parish Community Action Agency
• St. Landry Parish Rural Health Network, Inc.
• St. Landry Parish School Board
• St. Landry Parish School Board
• Darlene St. Romain
• Stability Staffing and Recruiting, LLC
• Stacey W Mayeaux MD LLC
• Tama Stears, MSW, CSW
• Brenda Stenson

• Family Medicine Physician in Opelousas, LA
• Providers in Opelousas, 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 Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.