Provider Demographics
NPI:1154048866
Name:MEDICAL MANAGERS
Entity type:Organization
Organization Name:MEDICAL MANAGERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-869-7838
Mailing Address - Street 1:1170 W CAUSEWAY APPROACH
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3038
Mailing Address - Country:US
Mailing Address - Phone:985-869-7838
Mailing Address - Fax:
Practice Address - Street 1:95 JUDGE TANNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7500
Practice Address - Country:US
Practice Address - Phone:985-869-7838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty