Provider Demographics
NPI:1104959741
Name:STAN J MAYS MD A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:STAN J MAYS MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-926-2258
Mailing Address - Street 1:4242 GUS YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-1733
Mailing Address - Country:US
Mailing Address - Phone:225-926-2258
Mailing Address - Fax:225-925-2520
Practice Address - Street 1:4242 GUS YOUNG AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-1733
Practice Address - Country:US
Practice Address - Phone:225-926-2258
Practice Address - Fax:225-925-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL18505261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CM81Medicare PIN
LAB65047Medicare UPIN