Provider Demographics
NPI:1104078583
Name:NORTHSHORE INTERPRETIVE MEDICINE
Entity type:Organization
Organization Name:NORTHSHORE INTERPRETIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA/CNIM
Authorized Official - Phone:985-727-3489
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-0761
Mailing Address - Country:US
Mailing Address - Phone:985-727-3489
Mailing Address - Fax:985-727-3490
Practice Address - Street 1:602 LAFAYETTE ST UNIT B
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5013
Practice Address - Country:US
Practice Address - Phone:985-727-3489
Practice Address - Fax:985-727-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty