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2025 Gravier Street 5th Floor New Orleans LA 70112-0000 | |
(504) 903-2373 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 2025 Gravier Street, New Orleans, Louisiana |
Authorized Official Name and Position | Gerard Bellocq (CFO) |
Authorized Official Contact | 5049035153 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1541 Tulane Ave Room 504 New Orleans LA 70112-2821 Ph: (504) 903-5153 | 2025 Gravier Street 5th Floor New Orleans LA 70112-0000 Ph: (504) 903-2373 |
NPI Number | 1922380740 |
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Provider Enumeration Date | 09/19/2011 |
Last Update Date | 09/19/2011 |
Identifier | Type | State | Issuer |
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1922380740 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 191 (Louisiana) | Primary |
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