MEDICARE: JOSEPH S CLARK PREPARATORY HIGH SCHOOL

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	251300000X	Local Education Agency (LEA)		LA

General Provider Information

NPI Number	:	1407118821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH S CLARK PREPARATORY HIGH SCHOOL

Provider Business Mailing Address
First Line	:	1301 N DERBIGNY ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70116-2213
Country	:	US
Telephone Number	:	504-373-6202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 N DERBIGNY ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70116-2213
Country	:	US
Telephone Number	:	504-373-6202
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOESPH E. NEARY
Credential	:
Telephone Number	:	504-952-3613

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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