| |
4001 Gen Degaulle Dr Suite H New Orleans LA 70114-8220 | |
(504) 365-9906 | |
(504) 365-9902 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 4001 Gen Degaulle Dr, New Orleans, Louisiana |
Authorized Official Name and Position | Bertrand Tillery (PHYSICIAN) |
Authorized Official Contact | 5043659906 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4001 Gen Degaulle Dr Suite H New Orleans LA 70114-8220 Ph: (504) 365-9906 | 4001 Gen Degaulle Dr Suite H New Orleans LA 70114-8220 Ph: (504) 365-9906 |
NPI Number | 1194870782 |
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Provider Enumeration Date | 01/24/2007 |
Last Update Date | 12/22/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194870782 | NPI | - | NPPES |
1576794 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 025561 (Louisiana) | Primary |
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