Healthcare Provider Details

I. General information

NPI: 1720328313
Provider Name (Legal Business Name): PARADIGM HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 LOUIS PRIMA DR SUITE B
COVINGTON LA
70433-5903
US

IV. Provider business mailing address

90 LOUIS PRIMA DR SUITE B
COVINGTON LA
70433-5903
US

V. Phone/Fax

Practice location:
  • Phone: 985-801-0571
  • Fax: 985-871-8109
Mailing address:
  • Phone: 985-801-0571
  • Fax: 985-871-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number202018
License Number StateLA

VIII. Authorized Official

Name: MR. GREGG J MORREAU
Title or Position: CEO
Credential:
Phone: 985-801-0581