| |
1300 Oretha Castle Haley Blvd Suite B New Orleans LA 70113-1001 | |
(504) 899-5437 | |
(504) 899-8668 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1300 Oretha Castle Haley Blvd, New Orleans, Louisiana |
Authorized Official Name and Position | Tanyelle Oatis-gaskew (LEAD CREDENTIALING SPECIALIST) |
Authorized Official Contact | 5044824080 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 13038 New Orleans LA 70185-3038 Ph: (504) 207-3060 | 1300 Oretha Castle Haley Blvd Suite B New Orleans LA 70113-1001 Ph: (504) 899-5437 |
NPI Number | 1457701575 |
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Provider Enumeration Date | 06/20/2016 |
Last Update Date | 12/18/2023 |
Medicare PECOS PAC ID | 3678755535 |
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Medicare Enrollment ID | O20240507000181 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457701575 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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