MEDICARE: BAPTIST COMMUNITY HEALTH SERVICES, INC.

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	207Q00000X	Family Medicine Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1952941767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST COMMUNITY HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	4960 SAINT CLAUDE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-4258
Country	:	US
Telephone Number	:	504-704-5949
Fax Number	:	504-704-5989

Provider Business Practice Location Address
First Line	:	1445 W CAUSEWAY APPROACH
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3045
Country	:	US
Telephone Number	:	504-533-4999
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE MGNT
Name	:	TINA MARIE BENANDI
Credential	:
Telephone Number	:	504-704-5949

Provider Enumeration Date	:	01/09/2020
Last Update Date	:	10/08/2021

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