Provider Demographics
NPI:1306913488
Name:GLEN D. HURLSTON, M.D., APMC
Entity type:Organization
Organization Name:GLEN D. HURLSTON, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HURLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-475-9927
Mailing Address - Street 1:PO BOX 54346
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4346
Mailing Address - Country:US
Mailing Address - Phone:337-475-9927
Mailing Address - Fax:337-475-9989
Practice Address - Street 1:1020 W FERTITTA BLVD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4649
Practice Address - Country:US
Practice Address - Phone:337-239-9041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949914Medicaid
LA5C558Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER