| |
711 N Broad St New Orleans LA 70119-4206 | |
(985) 307-1600 | |
(504) 575-3691 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 711 N Broad St, New Orleans, Louisiana |
Authorized Official Name and Position | Mark Keiser (PRESIDENT) |
Authorized Official Contact | 5045753712 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2900 Indiana Ave Kenner LA 70065-4605 Ph: (504) 575-3712 | 711 N Broad St New Orleans LA 70119-4206 Ph: (985) 307-1600 |
NPI Number | 1063759066 |
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Provider Enumeration Date | 01/10/2013 |
Last Update Date | 08/05/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063759066 | NPI | - | NPPES |
2324161 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (Louisiana) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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