| St Tammany Mandeville Chc | |
|
1150 W Causeway Approach Mandeville LA 70471-3038 | |
| (866) 530-6111 | |
| Not Available |
| Full Name | St Tammany Mandeville Chc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1150 W Causeway Approach, Mandeville, Louisiana |
| Authorized Official Name and Position | Mark Keiser (CEO) |
| Authorized Official Contact | 5045753700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Tammany Mandeville Chc 2900 Indiana Ave Kenner LA 70065-4605 Ph: (504) 575-3712 | St Tammany Mandeville Chc 1150 W Causeway Approach Mandeville LA 70471-3038 Ph: (866) 530-6111 |
| NPI Number | 1548818925 |
|---|---|
| Provider Enumeration Date | 08/29/2019 |
| Last Update Date | 04/11/2022 |
| Medicare PECOS PAC ID | 3678484276 |
|---|---|
| Medicare Enrollment ID | O20200318001627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548818925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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