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Contact Information

TILLMAN MEDICAL GROUP PA
800 AUDUBON DR
JONESVILLE, LA71343
 Phone: 318-339-4112
 Fax: 318-339-6388
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for TILLMAN MEDICAL GROUP PA

NPI # 1922124312
LBN Legal business name TILLMAN MEDICAL GROUP PA
Authorized official SUSAN DAVIS - (ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 03/21/2007
Last updated 07/08/2008 - About 18 years ago
Identifiers
LA License # 07480R
LA Medicaid 1447498
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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