Healthcare Provider Details

I. General information

NPI: 1366721409
Provider Name (Legal Business Name): MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 GRAVIER STREET
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

2021 PERDIDO ST
NEW ORLEANS LA
70112-1352
US

V. Phone/Fax

Practice location:
  • Phone: 504-903-2373
  • Fax: 504-903-1163
Mailing address:
  • Phone: 504-903-5153
  • Fax: 504-680-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number191
License Number StateLA

VIII. Authorized Official

Name: ROXANE A. TOWNSEND
Title or Position: INTERIM CHIEF FINANCIAL OFFICER
Credential: M.D.
Phone: 504-903-4907