Provider Demographics
NPI:1811643232
Name:MILLENNIUM NEONATOLOGY OF LOUISIANA PLLC
Entity type:Organization
Organization Name:MILLENNIUM NEONATOLOGY OF LOUISIANA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:RATTRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:552-229-6378
Mailing Address - Street 1:PO BOX 20236
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-0236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 W GAUTHIER RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7170
Practice Address - Country:US
Practice Address - Phone:855-222-9637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLENNIUM MEDICAL GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty