MEDICARE: BASE NEW ORLEANS CLINIC

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	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number	:	1780742049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASE NEW ORLEANS CLINIC

Provider Business Mailing Address
First Line	:	1790 SATURN ROAD
Second Line	:	HS DIVISION -- HEALTH SERVICES ADMINISTRATOR
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129
Country	:	US
Telephone Number	:	504-253-4671
Fax Number	:	504-253-4717

Provider Business Practice Location Address
First Line	:	1790 SATURN ST
Second Line	:	USCG BASE NOLA MEDICAL CLINIC
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2270
Country	:	US
Telephone Number	:	504-253-4717
Fax Number	:	504-253-4717

Authorized Official
Title or Position	:	HEALTH SERVICES ADMINISTRATOR
Name	:	MR. ANTONIO COLE
Credential	:	HSA
Telephone Number	:	504-253-4677

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	11/19/2014

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Directions to “BASE NEW ORLEANS CLINIC ” Practice Location

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