MEDICARE: COMPREHENSIVE MEDICAL ASSOCIATES OF NEW ORLEANS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	025561	LA

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

General Provider Information

NPI Number	:	1194870782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE MEDICAL ASSOCIATES OF NEW ORLEANS, LLC

Provider Business Mailing Address
First Line	:	4001 GEN DEGAULLE DR
Second Line	:	SUITE H
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-8220
Country	:	US
Telephone Number	:	504-365-9906
Fax Number	:	504-365-9902

Provider Business Practice Location Address
First Line	:	4001 GEN DEGAULLE DR
Second Line	:	SUITE H
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-8220
Country	:	US
Telephone Number	:	504-365-9906
Fax Number	:	504-365-9902

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. BERTRAND TILLERY JR.
Credential	:	MD
Telephone Number	:	504-365-9906

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	12/22/2016

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