Provider Demographics
NPI:1215474663
Name:QUIT SMOKING LOUISIANA LLC
Entity type:Organization
Organization Name:QUIT SMOKING LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:N
Authorized Official - Last Name:HEINEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-457-8166
Mailing Address - Street 1:151 LEON AVE
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3937
Mailing Address - Country:US
Mailing Address - Phone:337-457-8166
Mailing Address - Fax:888-371-3069
Practice Address - Street 1:151 LEON AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3937
Practice Address - Country:US
Practice Address - Phone:337-457-8166
Practice Address - Fax:888-371-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty