| |
4701 S Carrollton Ave New Orleans LA 70119-6026 | |
(504) 494-3895 | |
Not Available |
Full Name | |
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Speciality | General Practice |
Location | 4701 S Carrollton Ave, New Orleans, Louisiana |
Authorized Official Name and Position | Shawndrick R. Redding (OWNER AUTHORIZED) |
Authorized Official Contact | 2254490102 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4701 S Carrollton Ave New Orleans LA 70119-6026 Ph: (504) 494-3895 | 4701 S Carrollton Ave New Orleans LA 70119-6026 Ph: (504) 494-3895 |
NPI Number | 1669256384 |
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Provider Enumeration Date | 08/23/2023 |
Last Update Date | 07/09/2024 |
Medicare PECOS PAC ID | 7810436094 |
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Medicare Enrollment ID | O20240903000088 |
Identifier | Type | State | Issuer |
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1669256384 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Emery A Minnard |
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Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1790887677 PECOS PAC ID: 7315905932 Enrollment ID: I20041229000740 |
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