Provider Demographics
NPI:1962582577
Name:HAMMOND DERMATOLOGY CENTER, LLC
Entity type:Organization
Organization Name:HAMMOND DERMATOLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HENCHY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:985-542-9333
Mailing Address - Street 1:15709 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1452
Mailing Address - Country:US
Mailing Address - Phone:985-542-9333
Mailing Address - Fax:985-542-4988
Practice Address - Street 1:15709 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1452
Practice Address - Country:US
Practice Address - Phone:985-542-9333
Practice Address - Fax:985-542-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4093595OtherAETNA PROVIDER #
LA439748825BOtherBLUE BROSS OF LA.
LA1443841Medicaid
LA1443841Medicaid
LAB61223Medicare UPIN