Nightwater Clinic, Llc | |
719 Okeefe Ave New Orleans LA 70113-1906 | |
(504) 381-4204 | |
Not Available |
Full Name | Nightwater Clinic, Llc |
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Speciality | Clinic/Center |
Location | 719 Okeefe Ave, New Orleans, Louisiana |
Authorized Official Name and Position | Paul Ikemire (MEMBER) |
Authorized Official Contact | 5043722948 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Nightwater Clinic, Llc 111 Water St Ste 4 Exeter NH 03833-2456 Ph: (603) 247-5442 | Nightwater Clinic, Llc 719 Okeefe Ave New Orleans LA 70113-1906 Ph: (504) 381-4204 |
NPI Number | 1407369820 |
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Provider Enumeration Date | 11/07/2017 |
Last Update Date | 09/29/2022 |
Medicare PECOS PAC ID | 1951662501 |
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Medicare Enrollment ID | O20180223000280 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407369820 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Paul Aaron Ross Ikemire |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1477870210 PECOS PAC ID: 4789983511 Enrollment ID: I20161025002805 |
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