| |
1415 Tulane Ave 5 Th Floor Ste 5501 New Orleans LA 70112-2600 | |
(504) 575-3712 | |
(504) 575-3691 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1415 Tulane Ave, New Orleans, Louisiana |
Authorized Official Name and Position | Mark Keiser (PRESIDENT) |
Authorized Official Contact | 5045753712 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2900 Indiana Ave Kenner LA 70065-4605 Ph: (504) 575-3712 | 1415 Tulane Ave 5 Th Floor Ste 5501 New Orleans LA 70112-2600 Ph: (504) 575-3712 |
NPI Number | 1760841738 |
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Provider Enumeration Date | 02/18/2016 |
Last Update Date | 09/15/2016 |
Identifier | Type | State | Issuer |
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1760841738 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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