NPIMap

Organization Active NPI

Waldheim Family Practice Clinic

  • Family Medicine Physician
  • Covington, LA
National Provider Identifier
1811183221
Registry record updated Sep 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
017339 Issued in LA
Legal business name
WALDHEIM FAMILY PRACTICE CLINIC
Practice address
77173 Highway 21
Covington, LA 70435-4011
Phone
(985) 893-0486
Fax
(985) 893-0349
NPI assigned
Sep 19, 2007
Last updated
Sep 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2007

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

Authorized official

Name
Dr. Richard J Sanders Jr., M.D.NPI 1295897726
Title
Physician
Phone
(985) 893-0486

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 017339 LA Primary

Addresses

Primary practice location

77173 Highway 21
Covington, LA 70435-4011

Mailing address

77173 Highway 21
Covington, LA 70435-4011
Phone (985) 893-0486

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190160000000",
    "number": "1811183221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77173 HIGHWAY 21",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704354011",
            "telephone_number": "985-893-0486",
            "fax_number": "985-893-0349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77173 HIGHWAY 21",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704354011",
            "telephone_number": "985-893-0486",
            "fax_number": "985-893-0349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALDHEIM FAMILY PRACTICE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-19",
        "last_updated": "2007-09-19",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "985-893-0486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "017339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; 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.