Healthcare Provider Details

I. General information

NPI: 1386717536
Provider Name (Legal Business Name): MED-AID CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 ESSEN LN
BATON ROUGE LA
70809-3547
US

IV. Provider business mailing address

5475 ESSEN LN
BATON ROUGE LA
70809-3547
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-2750
  • Fax: 225-767-2832
Mailing address:
  • Phone: 225-767-2750
  • Fax: 225-767-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number014900
License Number StateLA

VIII. Authorized Official

Name: CHARLES TESSIER III
Title or Position: M.D.
Credential: M.D.
Phone: 225-767-2750