| Northshore Family Medicine, Llc | |
|
1119 S Tyler St Covington LA 70433-2327 | |
| (985) 875-9166 | |
| (985) 875-9170 |
| Full Name | Northshore Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1119 S Tyler St, Covington, Louisiana |
| Authorized Official Name and Position | Charles Balette (OWNER) |
| Authorized Official Contact | 9858759166 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northshore Family Medicine, Llc 1417 Stillwater Dr Mandeville LA 70471-7452 Ph: (985) 875-9166 | Northshore Family Medicine, Llc 1119 S Tyler St Covington LA 70433-2327 Ph: (985) 875-9166 |
| NPI Number | 1134194095 |
|---|---|
| Provider Enumeration Date | 02/22/2006 |
| Last Update Date | 10/29/2009 |
| Medicare PECOS PAC ID | 8527154657 |
|---|---|
| Medicare Enrollment ID | O20080124000248 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134194095 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Charles Balette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851358816 PECOS PAC ID: 5193812246 Enrollment ID: I20080117000463 |
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