MOSS STREET MEDICAL CLINIC INC (NPI# 1417085192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417085192 |
| Entity Type | Organization |
| Organization Name | MOSS STREET MEDICAL CLINIC INC |
| Practice Address |
1417 Moss St Lafayette LA 70501-3654 |
| Practice Telephone | 3372323371 |
| Practice Fax Number | 3372323511 |
| Mailing Telephone | 3372323371 |
| Mailing Fax Number | 3372323511 |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | RICKIE EDWARD JOHNSON (OWNER) |
| Authorized Official Telephone | 3372323371 |
| Authorized Official Credential | PA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
A10226 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1448397 | 05 |
| Street Address |
1417 MOSS ST |
| City | LAFAYETTE |
| State | LA |
| Zip Code | 70501-3654 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326646134 | Gifted Hands Caregiver | Home Health Aide | 213 Grimsby St., Fafayette, LA 70501 | 2020-10-14 |
| 1740888551 | Complete Count LLC | Home Health | 713 South Orange St, Lafayette, LA 70501 | 2020-10-14 |
| 1154891471 | Lesha May | Case Manager/Care Coordinator | 113 W Covent St, Lafayette, LA 70501 | 2018-11-29 |
| 1871023994 | Nancy Bass Texada | Community/Behavioral Health | 525 South Buchanan, Lafayette, LA 70501 | 2017-06-13 |
| 1447706700 | Medicine Bin Plus LLC | Pharmacy | 1105 West Willow St, Lafayette, LA 70501 | 2016-08-28 |
| 1508227968 | Vicky Marie Senegal | Home Health Aide | 304 1/2 Rubria St., Lafayette, LA 70501 | 2016-03-14 |
| 1558766931 | Corey Gerard Porche | Counselor | 708 Jefferson Blvd., Lafayette, LA 70501 | 2014-10-28 |
| 1518362219 | Sherry Riddle | Counselor | 119 Caillouet Place, Lafayette, LA 70501 | 2014-10-24 |
| 1285057893 | Hearsts of Hope | Counselor | 911 General Mouton Avenue, Lafayette, LA 70501 | 2014-02-03 |
| 1437408549 | Jensen J. Bergeron | Counselor | 600 Jefferson Street Suite 903, Lafayette, LA 70501 | 2012-09-05 |
| Find all providers in zip 70501 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093321788 | April Marie Przyborski | Physician Assistant | 1701 S Creasy Ln Ste 2j20, Lafayette, IN 47905-4972 | 2020-09-18 |
| 1932658002 | Taylor Christensen Mahtook | Physician Assistant | 4650 Ambassador Caffery Pkwy Ste 101, Lafayette, LA 70508-6926 | 2016-09-29 |
| 1871900936 | Leigh Hannah Culpepper | Physician Assistant | 200 Corporate Blvd Ste 201, Lafayette, LA 70508-3870 | 2014-07-21 |
| 1265623722 | Morgan Anne Mannina-williams | Physician Assistant | 1103 Kaliste Saloom Rd Ste 100, Lafayette, LA 70508-5784 | 2007-08-08 |
| 1245391960 | Lena Opitz Sevin | Physician Assistant | 105 Patriot St, Ste 101, Lafayette, LA 70508-6831 | 2006-12-13 |
| 1952413726 | Meaghan Tara Saint | Physician Assistant | 978 2nd St Ste 220, Lafayette, CA 94549-4546 | 2006-08-31 |
| 1962467894 | Lucy Judson | Physician Assistant | 2000 W South Boulder Road, Lafayette, CO 80026-1389 | 2006-04-20 |
| 1609845130 | Emergency Group of Lafayette LLC | Physician Assistant | 1105 Kaliste Saloom Rd, Lafayette, LA 70508-5705 | 2006-03-16 |
| 1336138692 | Natalie Deshotels | Physician Assistant | 443 Heymann Blvd, Suite A, Lafayette, LA 70503-2632 | 2005-10-19 |
| 1457358913 | Alicia Pate | Physician Assistant | 3900 St Francis Way Ste 201, Lafayette, IN 47905-4923 | 2005-06-30 |
| Find all providers in LAFAYETTE | ||||
Please comment or provide details below to improve the information on MOSS STREET MEDICAL CLINIC INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.