Provider Demographics
NPI:1902102635
Name:MEDEX CLINICAL CONSULTANTS PLLC
Entity Type:Organization
Organization Name:MEDEX CLINICAL CONSULTANTS PLLC
Other - Org Name:MEDICAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:DEXTER
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:504-669-0774
Mailing Address - Street 1:1410 GAUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2206
Mailing Address - Country:US
Mailing Address - Phone:985-726-0500
Mailing Address - Fax:985-726-0544
Practice Address - Street 1:1410 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2206
Practice Address - Country:US
Practice Address - Phone:985-726-0500
Practice Address - Fax:985-726-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024429261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center