Provider Demographics
NPI:1306089511
Name:STERLINGTON VILLAGE LLC
Entity type:Organization
Organization Name:STERLINGTON VILLAGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-812-2304
Mailing Address - Street 1:10374 HIGHWAY 165 N STE D
Mailing Address - Street 2:
Mailing Address - City:STERLINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:71280-3320
Mailing Address - Country:US
Mailing Address - Phone:318-812-2304
Mailing Address - Fax:318-812-2306
Practice Address - Street 1:10374 HIGHWAY 165 N STE D
Practice Address - Street 2:
Practice Address - City:STERLINGTON
Practice Address - State:LA
Practice Address - Zip Code:71280-3320
Practice Address - Country:US
Practice Address - Phone:318-812-2304
Practice Address - Fax:318-812-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DK10Medicare PIN