Healthcare Provider Details

I. General information

NPI: 1184239642
Provider Name (Legal Business Name): ACCESS HEALTH LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HUEY P LONG AVE
GRETNA LA
70053-6436
US

IV. Provider business mailing address

2900 INDIANA AVE
KENNER LA
70065-4605
US

V. Phone/Fax

Practice location:
  • Phone: 866-530-6111
  • Fax:
Mailing address:
  • Phone: 504-575-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARK KEISER
Title or Position: CEO
Credential:
Phone: 504-575-3700