| Immi, Llc | |
|
10101 Park Rowe Ave Baton Rouge LA 70810-1686 | |
| (225) 769-2200 | |
| Not Available |
| Full Name | Immi, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10101 Park Rowe Ave, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Jess Duet Anderson (OWNER/PHYSICIAN) |
| Authorized Official Contact | 9856376629 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Immi, Llc 2310 Marianne Ave Zachary LA 70791-2740 Ph: (985) 637-6629 | Immi, Llc 10101 Park Rowe Ave Baton Rouge LA 70810-1686 Ph: (225) 769-2200 |
| NPI Number | 1902549637 |
|---|---|
| Provider Enumeration Date | 04/20/2022 |
| Last Update Date | 04/20/2022 |
| Medicare PECOS PAC ID | 3971990508 |
|---|---|
| Medicare Enrollment ID | O20220428000876 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902549637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jess N Anderson |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1568623395 PECOS PAC ID: 4284804634 Enrollment ID: I20110823000550 |
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