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NPI Code Detail

MEDICARE: OLOL-ASCENSION

MEDICARE: OLOL-ASCENSION
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
1207Q00000XFamily Medicine Physician013784LA

Other Identifiers

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

General Provider Information

NPI Number : 1730111790
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLOL-ASCENSION
Provider Business Mailing Address
First Line : 2647 S RIVERVIEW BLVD
Second Line : SUITE 100
City : GONZALES
State : LA
Zip : 70737-5021
Country : US
Telephone Number : 225-647-8511
Fax Number : 225-644-5213
Provider Business Practice Location Address
First Line : 1702 N BURNSIDE AVE
Second Line : SUITE B
City : GONZALES
State : LA
Zip : 70737-5021
Country : US
Telephone Number : 225-647-8511
Fax Number : 225-644-5213
Authorized Official
Title or Position : CEO
Name : JOHN F. FRAICHE
Credential : M.D.
Telephone Number : 225-647-8511
Provider Enumeration Date : 07/07/2006
Last Update Date : 08/06/2007

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Practice Location Address:
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1336138494 — DR. RODNEY E HILLIS M.D.
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1437115037 — BERNARD B BRACH MD
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1306899067 — OUR LADY OF LAKE ASCENSION, LLC
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1790853901 — DR. MOHAMMED SAEED M.D.
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Directions to “OLOL-ASCENSION ” Practice Location

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