MEDICARE: AZALEA MEDICAL, L.L.C.

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	251T00000X	PACE Provider Organization	201310	FL
2	207Q00000X	Family Medicine Physician	201310	LA

General Provider Information

NPI Number	:	1942629589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZALEA MEDICAL, L.L.C.

Provider Business Mailing Address
First Line	:	3305 METAIRIE RD.
Second Line	:	STE. 1
City	:	METAIRIE
State	:	LA
Zip	:	70001
Country	:	US
Telephone Number	:	504-434-2330
Fax Number	:	504-885-0820

Provider Business Practice Location Address
First Line	:	3305 METAIRIE RD.
Second Line	:	STE. 1
City	:	METAIRIE
State	:	LA
Zip	:	70001
Country	:	US
Telephone Number	:	504-434-2330
Fax Number	:	504-885-0820

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KATHARINE J. ROSE
Credential	:	M.D.
Telephone Number	:	504-434-2330

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	02/28/2019

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