| Deluxe Medical Corporation | |
|
3640 Lake Aspen Dr W Gretna LA 70056-8303 | |
| (504) 418-4226 | |
| (504) 365-9902 |
| Full Name | Deluxe Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 3640 Lake Aspen Dr W, Gretna, Louisiana |
| Authorized Official Name and Position | Bertrand Tillery (PHYSICIAN) |
| Authorized Official Contact | 5044185226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deluxe Medical Corporation 3640 Lake Aspen Dr W Gretna LA 70056-8303 Ph: (504) 418-4226 | Deluxe Medical Corporation 3640 Lake Aspen Dr W Gretna LA 70056-8303 Ph: (504) 418-4226 |
| NPI Number | 1255899936 |
|---|---|
| Provider Enumeration Date | 03/12/2019 |
| Last Update Date | 03/12/2019 |
| Medicare PECOS PAC ID | 7214260785 |
|---|---|
| Medicare Enrollment ID | O20190615000069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255899936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Bertrand Tillery |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700852241 PECOS PAC ID: 0446233969 Enrollment ID: I20040608000006 |
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