Provider Demographics
NPI:1649680091
Name:INDUSTRIAL OCCUPATIONAL SAFETY COUNCIL
Entity type:Organization
Organization Name:INDUSTRIAL OCCUPATIONAL SAFETY COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:Q
Authorized Official - Last Name:THIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:225-570-8474
Mailing Address - Street 1:9305 MAIN ST
Mailing Address - Street 2:STE E
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-7441
Mailing Address - Country:US
Mailing Address - Phone:225-570-8474
Mailing Address - Fax:225-208-1035
Practice Address - Street 1:9305 MAIN ST
Practice Address - Street 2:STE E
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7441
Practice Address - Country:US
Practice Address - Phone:225-570-8474
Practice Address - Fax:225-208-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06891261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA075950YK2HOtherMEDICARE
LA2338871Medicaid