MEDICARE: KENNER EMERGENCY GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363AM0700X	Medical Physician Assistant
2	363L00000X	Nurse Practitioner
3	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013986546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNER EMERGENCY GROUP LLC

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 W ESPLANADE AVE
Second Line	:
City	:	KENNER
State	:	LA
Zip	:	70065-2467
Country	:	US
Telephone Number	:	504-468-8600
Fax Number	:

Authorized Official
Title or Position	:	VP OF CONTRACTING
Name	:	LISHA C FALK
Credential	:
Telephone Number	:	337-609-1221

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	03/23/2022

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Directions to “KENNER EMERGENCY GROUP LLC ” Practice Location

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