Provider Demographics
NPI:1316451966
Name:PHYSICAL EXAM SERVICES, LLC
Entity type:Organization
Organization Name:PHYSICAL EXAM SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHEXNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:318-729-6003
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:LECOMPTE
Mailing Address - State:LA
Mailing Address - Zip Code:71346-0124
Mailing Address - Country:US
Mailing Address - Phone:318-729-6003
Mailing Address - Fax:
Practice Address - Street 1:68 H. STRANGE RD.
Practice Address - Street 2:
Practice Address - City:LECOMPTE
Practice Address - State:LA
Practice Address - Zip Code:71346-7134
Practice Address - Country:US
Practice Address - Phone:318-729-6003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261Q00000X
363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1477537066OtherFREE NATIONAL NPI