Provider Demographics
NPI:1124174917
Name:LAXMI LLC
Entity type:Organization
Organization Name:LAXMI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:T.
Authorized Official - Middle Name:MURALI
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-495-2379
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35740-0920
Mailing Address - Country:US
Mailing Address - Phone:256-437-9700
Mailing Address - Fax:256-437-8303
Practice Address - Street 1:47005 AL HIGHWAY 277
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:AL
Practice Address - Zip Code:35740-7205
Practice Address - Country:US
Practice Address - Phone:256-437-9700
Practice Address - Fax:256-437-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty