Provider Demographics
NPI:1104887538
Name:EMILE A BARROW JR MD A MEDICAL CORP.
Entity type:Organization
Organization Name:EMILE A BARROW JR MD A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-361-9900
Mailing Address - Street 1:3510 MAGNOLIA CV
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2372
Mailing Address - Country:US
Mailing Address - Phone:318-364-9900
Mailing Address - Fax:318-361-0428
Practice Address - Street 1:3510 MAGNOLIA CV
Practice Address - Street 2:SUITE 100
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2372
Practice Address - Country:US
Practice Address - Phone:318-364-9900
Practice Address - Fax:318-361-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO3699363L00000X
LALO11453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1435082Medicaid
LA1303488Medicaid
LA5C812Medicare ID - Type UnspecifiedMEDICARE CLINIC NUMBER
LA1303488Medicaid
LAP19241Medicare UPIN
LA1435082Medicaid