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11312 Jefferson Hwy River Ridge LA 70123-1709 | |
(504) 464-0032 | |
(504) 466-3440 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 11312 Jefferson Hwy, River Ridge, Louisiana |
Authorized Official Name and Position | Patricia Ann Bowman (CO-CHAIR) |
Authorized Official Contact | 5044640032 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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11312 Jefferson Hwy River Ridge LA 70123-1709 Ph: (504) 464-0032 | 11312 Jefferson Hwy River Ridge LA 70123-1709 Ph: (504) 464-0032 |
NPI Number | 1174664510 |
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Provider Enumeration Date | 02/09/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174664510 | NPI | - | NPPES |
1947652 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 80-001271 (Louisiana) | Primary |