Provider Demographics
NPI:1487886867
Name:M TERESA VIVES MD LLC
Entity type:Organization
Organization Name:M TERESA VIVES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-898-2001
Mailing Address - Street 1:1437 AMELIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3623
Mailing Address - Country:US
Mailing Address - Phone:504-899-4005
Mailing Address - Fax:504-899-4993
Practice Address - Street 1:185 GREENBRIAR BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7234
Practice Address - Country:US
Practice Address - Phone:985-898-2001
Practice Address - Fax:985-898-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10138R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431818Medicaid
LA1431818Medicaid