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5140 Church St Lafitte LA 70067-5256 | |
(504) 689-3300 | |
(504) 689-8223 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 5140 Church St, Lafitte, Louisiana |
Authorized Official Name and Position | Shondra G Williams (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5047628931 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 2490 Marrero LA 70073-2490 Ph: (504) 437-8528 | 5140 Church St Lafitte LA 70067-5256 Ph: (504) 689-3300 |
NPI Number | 1528483849 |
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Provider Enumeration Date | 02/24/2014 |
Last Update Date | 02/24/2014 |
Identifier | Type | State | Issuer |
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1528483849 | NPI | - | NPPES |
2337238 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |