Provider Demographics
NPI:1124645130
Name:BAYOU TELEMEDICINE LLC
Entity type:Organization
Organization Name:BAYOU TELEMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-819-3218
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1221
Mailing Address - Country:US
Mailing Address - Phone:800-819-3218
Mailing Address - Fax:800-819-6261
Practice Address - Street 1:1703 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-3632
Practice Address - Country:US
Practice Address - Phone:800-819-3218
Practice Address - Fax:800-819-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center