Provider Demographics
NPI:1407369820
Name:NIGHTWATER CLINIC, LLC
Entity type:Organization
Organization Name:NIGHTWATER CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:IKEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-372-2948
Mailing Address - Street 1:111 WATER ST STE 4
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2456
Mailing Address - Country:US
Mailing Address - Phone:603-247-5442
Mailing Address - Fax:
Practice Address - Street 1:719 OKEEFE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1906
Practice Address - Country:US
Practice Address - Phone:504-381-4204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIGHTWATER HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-07
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care