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5140 Church St Lafitte LA 70067-5256 | |
(504) 349-6525 | |
(504) 349-6529 |
Full Name | |
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Speciality | Family Medicine |
Location | 5140 Church St, Lafitte, Louisiana |
Authorized Official Name and Position | Heidi A Gwinn (CREDENTIALING COORD.) |
Authorized Official Contact | 5043491297 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5140 Church St Lafitte LA 70067-5256 Ph: (504) 349-6525 | 5140 Church St Lafitte LA 70067-5256 Ph: (504) 349-6525 |
NPI Number | 1831266162 |
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Provider Enumeration Date | 11/30/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831266162 | NPI | - | NPPES |
1942545 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |