| Northlake Medicine And Wellness Center, Llc | |
|
1980 N Highway 190 Covington LA 70433-5158 | |
| (985) 809-6195 | |
| (985) 809-6199 |
| Full Name | Northlake Medicine And Wellness Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1980 N Highway 190, Covington, Louisiana |
| Authorized Official Name and Position | Tania Ann Levi (OWNER) |
| Authorized Official Contact | 9858096195 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northlake Medicine And Wellness Center, Llc 1980 N Highway 190 Covington LA 70433-5158 Ph: (985) 809-6195 | Northlake Medicine And Wellness Center, Llc 1980 N Highway 190 Covington LA 70433-5158 Ph: (985) 809-6195 |
| NPI Number | 1073693958 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 08/16/2010 |
| Medicare PECOS PAC ID | 5597764183 |
|---|---|
| Medicare Enrollment ID | O20061208000218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073693958 | NPI | - | NPPES |
| 1378054 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 018251 (Louisiana) | Primary |
| Provider Name | Tania Levi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629058813 PECOS PAC ID: 0345249934 Enrollment ID: I20061208000195 |
| Provider Name | Lacy C Mills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477873362 PECOS PAC ID: 3971780479 Enrollment ID: I20110610000022 |
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