| Mckenna General Medical, Llc | |
|
1827 Gentilly Blvd New Orleans LA 70119-2051 | |
| (504) 943-1923 | |
| (504) 943-1933 |
| Full Name | Mckenna General Medical, Llc |
|---|---|
| Speciality | General Practice |
| Location | 1827 Gentilly Blvd, New Orleans, Louisiana |
| Authorized Official Name and Position | Dwight Lawrence Mckenna (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 5049431923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mckenna General Medical, Llc 1827 Gentilly Blvd New Orleans LA 70119-2051 Ph: (504) 943-1923 | Mckenna General Medical, Llc 1827 Gentilly Blvd New Orleans LA 70119-2051 Ph: (504) 943-1923 |
| NPI Number | 1164683645 |
|---|---|
| Provider Enumeration Date | 06/18/2008 |
| Last Update Date | 08/12/2011 |
| Medicare PECOS PAC ID | 0749455434 |
|---|---|
| Medicare Enrollment ID | O20111207000752 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164683645 | NPI | - | NPPES |
| 1129267 | Medicaid | LA | |
| UP4206 | Other | LA | UNITED HEALTHCARE |
| F4229 | Other | LA | BLUE CROSS/BLUE SHIELD |
| 436664206B | Other | LA | BLUE CROSS/BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Dwight L Mckenna |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1316056419 PECOS PAC ID: 2860497963 Enrollment ID: I20060925000114 |
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